Download Learning and assessment plan: screening clinics and ED

Advanced musculoskeletal
physiotherapy in the
orthopaedic and neurosurgery
physiotherapy screening clinics, ED
soft tissue review clinic
Workbook
Prepared by Alfred Health on behalf of the Department of Health, Victoria.
© 2014
1
Contents
Background ......................................................................................................................................... 3
Scope of practice statement – orthopaedic and neurosurgery screening clinics, ED soft tissue
review clinic ......................................................................................................................................... 4
Competency standard – delivering advanced musculoskeletal physiotherapy in the orthopaedic and
Neurosurgical screening clinic and ED soft tissue review clinic .......................................................... 5
Learning needs analysis Part A and B: screening and ED soft tissue review clinics ........................ 31
Competency standard self-assessment tool- Part A of the learning needs analysis: screening and
ED soft tissue review clinic ................................................................................................................ 32
Knowledge and skills self-assessment – Part B of the learning needs analysis: screening and ED
soft tissue review clinics .................................................................................................................... 40
Learning and assessment plan: screening clinics and ED soft tissue review clinics (example only) 68
Workplace learning program ............................................................................................................. 75
Competency based assessment and related tools ........................................................................... 78
Curriculum overview ........................................................................................................................ 131
Glossary........................................................................................................................................... 134
References ...................................................................................................................................... 134
Bibliography ..................................................................................................................................... 135
2
Background
This workbook contains the resources for the competency-based learning and assessment program
for advanced musculoskeletal physiotherapists commencing work in the orthopaedic and
neurosurgery screening and emergency department (ED) soft tissue review clinics. It needs to be
read in conjunction with each individual organisation’s policy and procedures for delivering advanced
musculoskeletal physiotherapy services and, in particular, with the operational guidelines and clinical
governance policy for the relevant advanced musculoskeletal physiotherapy service. The
competency-based learning and assessment program is designed to be flexible and tailored to suit
the needs of the individual physiotherapist and the needs of the organisation. Therefore decisions
regarding the detail of the program need to be made for each organisation by the clinical lead
physiotherapist in collaboration with the orthopaedic, neurosurgery or emergency department. This
workbook provides the framework to be used along with examples of the learning and assessment
program. Organisations may choose to include additional learning and assessment tasks, or do away
with some of the proposed tasks depending on the experience and skills of the individual, resources
available and requirements of the medical and physiotherapy departments, and the organisation as a
whole.
A summary of the key components of the competency-based learning and assessment program
contained in this workbook specifically written for the orthopaedic and neurosurgery, ED soft tissue
review clinics are as follows:






the scope of practice definition
the competency standard
Competency standard self-assessment tool (Part A of the Learning needs analysis)
Learning needs analysis (Part A and B)
Learning and assessment plan
assessment and related tools.
3
Scope of practice statement – orthopaedic and neurosurgery screening clinics, ED soft tissue review clinic
The scope of practice for advanced musculoskeletal physiotherapists in the musculoskeletal screening clinics is diverse and may include waitlist triage,
orthopaedic screening clinics, neurosurgery spinal pain screening clinics and low-acuity referral from ED clinics. The roles typically include managing
patients referred to the orthopaedic or neurosurgery specialists with non-urgent spinal or peripheral (shoulder, hip, and knee) conditions (category 3, 4
and 5). The physiotherapist is responsible for comprehensively assessing, diagnosing and formulating and undertaking a comprehensive management
plan alone or in conjunction with expert colleagues. The physiotherapist is responsible for: working within their scope of practice and developing
evidence-based management plans for patients in collaboration with their home unit; discussing with experts those patients who require more urgent
attention; referring to community-based healthcare providers or other outpatient units within the hospital or discharging appropriately from the service
those patients that require no further unit intervention; and communicating appropriately to the primary carer and unit consultant as required. Imaging
other than plain films is to be ordered only under the authority of the relevant consultant after collaboration or under agreed protocol for the health
organisation. Collaboration is recommended for any patient deemed to be requiring the input from the consultant either at the time of the appointment or
sometime after.
The physiotherapist will commence working under the supervision of the clinical lead (physiotherapist) with input from the relevant consultant until workbased competency standards have been met (refer to clinical education framework). Once competency has been achieved, the physiotherapist will be
deemed to work autonomously with patients presenting with simple, uncomplicated musculoskeletal presentations who, on assessment:
 present with no red or yellow flags

do not need imaging other than plain film

do not require the input from the orthopaedic or neurosurgery teams.
Any patients who do not meet the above criteria will need to be discussed with the orthopaedic or neurosurgery consultant. Regardless of being deemed
competent, a collaborative, team-based approach to patient care is strongly encouraged at all times while working in the orthopaedic and neurosurgery
screening clinics and the physiotherapist should remain in close consultation with the relevant consultant regarding any patient concerns.
4
Competency standard – delivering advanced musculoskeletal physiotherapy in the orthopaedic and
neurosurgical screening clinic and ED soft tissue review clinic
Refer to the Advanced musculoskeletal physiotherapy clinical education framework manual for details regarding the background and development of the
competency standard for advanced musculoskeletal physiotherapists delivering services in these clinics. In addition the pathway to competence in the
workplace that provides the steps involved to achieving competence is detailed in the manual. The diagram on the next page provides an overview of the
competency standard for the orthopaedic and neurosurgical screening clinic and ED soft tissue review clinic.
There are variations across Victoria in the model of care for advanced musculoskeletal physiotherapy clinics; therefore it may be that some of the domains
and performance criteria described in the competency standard may not apply to every organisation. For example, the prevalence of diabetes varies across
different demographics. If the prevalence of diabetes is high in the patient population the organisation services, it is recommended that the diabetes section of
the competency-based learning and assessment program be included, otherwise it may not be a high priority for learning and assessment, and there may be
other chronic illnesses more prevalent that warrant further knowledge.
5
6
Element
Elements describe the
essential outcome of the
competency standard
Performance criteria
The performance criteria specify the level of the
performance required to demonstrate
achievement of the element
Performance cues
Performance cues provide practical examples of what an independent
performer may look like in action
Professional behaviours
1. Operate within scope of
practice
1.1 Identify and act within own knowledge base
and scope of practice
1.2 Work towards the full extent of the role
2. Display accountability
2.1 Take responsibility for own actions, as it
applies to the practice context
 Confer with expert colleagues for a second opinion when unsure or
exposed to uncommon presentations
 Refrain from procedures outside scope
 Demonstrate a desire to acquire further knowledge and extend practice
to achieve full potential within scope of practice
 Extend the range of patient conditions/profile over time
 Annually review potential scope of practice in accordance with
organisational needs and current legislation
 Identify the additional responsibilities resulting from working in
substitution roles
 Identify the impact own decision making has on patient outcomes and
act to minimise risks
Lifelong learning
3. Demonstrate a
commitment to lifelong
learning
3.1 Engage in lifelong learning practices to
maintain and extend professional competence



3.2 Identify own professional development needs
and implement strategies for achieving them

3.3 Engage in both self-directed and practicebased learning

3.4 Reflect on clinical practice to identify strengths
and areas requiring further development
3.5 Formulate learning objectives and strategies
for addressing own limitations

Use methods to self-assess knowledge and clinical skills; for example,
engage in a clinical needs analysis or performance appraisal process
Design a plan to appropriately address identified learning needs
Maintain a comprehensive professional portfolio, including evidence
supporting achievement of identified needs
Actively participate in ongoing continued education programs, both inhouse and external
Prepare in advance for work-based assessment and/or continuing
education sessions
Initiate and create own learning opportunities, for example:
o follow up on uncommon or complex cases
o obtain and act on advice from other professionals to improve own
practice (medical and non-medical)
 Share clinical experiences that provide learning opportunities for others
 Conduct shadowing and learning from competent staff (medical and
non-medical)
7
Element
Elements describe the
essential outcome of the
competency standard
Performance criteria
The performance criteria specify the level of the
performance required to demonstrate
achievement of the element
Performance cues
Performance cues provide practical examples of what an independent
performer may look like in action
Communication
4. Communicate with
colleagues
4.1 Use concise, systematic communication at the
appropriate level when conversing with a range of
colleagues in the practice context
4.2 Present all relevant information to expert
colleagues when acting to obtain their
involvement
 Verbally present patients to consultant with appropriate brevity and preconsidered purpose using a systematic approach, such as the ISBAR
format (to assist with diagnosis and confirm management plan)
 When presenting cases, consistently include essential information while
excluding what is extraneous
 Write referral letters that are concise, legible, accurate and contain all
required information to accepted practice standards in a timely manner
 With the patient’s consent, consistently provide concise and accurate
reports back to referrer and community services containing assessment
finding, working diagnosis and plan
Provision and coordination of care
5. Evaluate referrals
5.1 Discern patients who are appropriate for
advanced physiotherapy management. Do this in
accordance with individual strengths or limitations,
any legal or organisational restrictions on practice,
the environment, the patient profile/needs and
within defined work roles
 Consistently discern patients who are appropriate for advanced
musculoskeletal physiotherapy management
 Consistently discern patients who are not appropriate for advanced
musculoskeletal physiotherapy management
 Engage in timely discussion and referral to expert colleagues for
appropriate cases
 Triage referrals accurately to available pathways
 Identify red flags from initial referrals and manage immediately and
appropriately
 Identify yellow flags of concern from initial referral and manage
appropriately
 Complete all necessary arrangements to facilitate triaged management
plans
 Ensure triage decisions are documented according to organisational
procedure
 In work prioritisation, consistently apply local organisational
requirements of patient flow
8
Element
Elements describe the
essential outcome of the
competency standard
Performance criteria
The performance criteria specify the level of the
performance required to demonstrate
achievement of the element
5.2 Discern patients who are appropriate for
management in a shared-care arrangement in
accordance with individual strengths or limitations,
any legal or organisational restrictions on practice,
the environment, the patient profile/needs and
within defined work roles
5.3 Defer patient referrals to relevant health
professionals (including other physiotherapists)
when limitations of skill or job role prevent the
patient’s needs from being adequately addressed
or when indicated by local triage procedure
Performance cues
Performance cues provide practical examples of what an independent
performer may look like in action

 Ensure relevant health professionals receive an accurate and timely
handover when transferring patient care, and that urgency of care is
understood
 Document referral/handover clearly with all necessary information
5.4 Prioritise referrals based on patient
profile/need, organisational procedure or targets,
and any local factors
5.5 Communicate action taken on referrals using
established organisational processes
6. Perform health
assessment/examination
6.1 Design and perform an individualised,
culturally appropriate and effective patient
interview for common and/or complex
conditions/presentations
History-taking skills include:
 History of presenting condition:
o
Chronological relevant sequence of events and symptoms
o
Mechanism of injury, location of injury and associated questions
relating to this such as, for falls, height, headstrike, loss of
consciousness, direction of force, position of limb and falls risk
o
Severity, irritability and nature of problem
o
Specific red flag and yellow flag questioning
 Consideration of the impact of presenting complaint on the patient such
as:
9
Element
Elements describe the
essential outcome of the
competency standard
Performance criteria
The performance criteria specify the level of the
performance required to demonstrate
achievement of the element
Performance cues
Performance cues provide practical examples of what an independent
performer may look like in action
o
functional activities, mental status, work and social implications
(measured via functional outcome measures where possible) and
mode of transport to appointment
o
compensable injuries, litigation
 Factors, medical or otherwise, that could influence treatment outcomes
or prognosis such as time since onset, initial/previous management and
efficacies, patient compliance and previous imaging including radiology
reports
 History of medications and other pain-related interventions such as:
o
current analgesia regimen (prescription and over-the-counter)
o
previous response to medications
o
past interventions that have been beneficial
o
past interventions that have not been beneficial
 Medical and surgical history including:
o
smoking, alcohol, recreational drug use
o
past history of presenting condition
 Neurological history and family history
 Social and family history, including:
o
hand dominance, sport, work, hobbies
o
social supports, dependants, access to home and work
 Screening for general health issues
 Population-specific questions, including predispositions, family history,
infectious diseases and overseas travel
 Ability to make a working diagnosis after taking a history
10
Element
Elements describe the
essential outcome of the
competency standard
Performance criteria
The performance criteria specify the level of the
performance required to demonstrate
achievement of the element
Performance cues
Performance cues provide practical examples of what an independent
performer may look like in action
History-taking skills are used to identify the following conditions or
presentations:
 Red flags or possible serious underlying pathology (special questions –
fevers, sweats, weight loss, incontinence, saddle paraesthesia, etc.)
 Yellow flags to indicate psychosocial factors exacerbating presenting
complaint
 Common musculoskeletal conditions including:
o
clinical patterns of pain and symptoms
o
24-hour symptom behaviour
o
aggs and eases
 Chronic widespread pain (mechanical or neuropathic) and acute pain
syndromes, such as complex regional pain syndrome (CRPS)
 Inflammatory versus non-inflammatory conditions
 Symptoms emanating from the nervous system
 More complex musculoskeletal presentations that require a medical
opinion
 When features do not fit a musculoskeletal diagnosis – that is, a
possible non-musculoskeletal cause of an apparent musculoskeletal
presentation
 Use history-taking skills to direct an appropriate physical examination,
use of investigations and outcome measures consistent with evidencebased practice
Physical examination skills include:
 Conduct an initial assessment, inclusive of skin condition and
musculoskeletal and neurological status, as indicated
 Demonstrate advanced skills in physical examination of the
neuromusculoskeletal system as it applies to the practice context, and
as directed by information obtained in history taking, including:
11
Element
Elements describe the
essential outcome of the
competency standard
Performance criteria
The performance criteria specify the level of the
performance required to demonstrate
achievement of the element
Performance cues
Performance cues provide practical examples of what an independent
performer may look like in action
o
routine musculoskeletal clinical examination
o
region-specific special tests
o
neurological examination – for example, upper motor neurone,
lower motor neurone, peripheral nerve and functional testing for
the presence of neuropathic pain when indicated (brush allodynia)
Physical examination skills are used to identify the following
conditions or presentations:









Common musculoskeletal presentations
Red flags or features suggesting serious underlying pathology
Screening for yellow flags
More complex musculoskeletal presentations that require a medical
opinion
Possible non-musculoskeletal cause of a musculoskeletal presentation
Regional pain (using relevant special tests for each joint or region)
Chronic widespread pain or acute regional pain syndrome
Signs of neurological disease localised to the correct neuraxis level
Neuropathic pain including CRPS
6.2 Formulate a preliminary hypothesis and
differential diagnoses for a patient with common
and/or complex conditions, as relevant to the
practice context
6.3 Perform complex modifications to routine
musculoskeletal assessment in recognition of
factors that may impact on the process, such as
the patient profile/needs and the practice context
6.4 Design and conduct an individualised,
culturally appropriate and effective clinical
assessment that:
12
Element
Elements describe the
essential outcome of the
competency standard
Performance criteria
The performance criteria specify the level of the
performance required to demonstrate
achievement of the element
Performance cues
Performance cues provide practical examples of what an independent
performer may look like in action
 is systems-based
 includes relevant clinical tests
 selects and measures relevant health
indicators
 substantiates the provisional diagnosis
6.5 Identify when input is required from expert
colleagues and act to obtain their involvement
6.6 Ensure all red flags are identified in the
assessment process, link red flags to diagnoses
not to be missed and take appropriate action in a
timely manner
6.7 Ensure yellow flags are identified in the
assessment process and take appropriate action
in a timely manner
7. Apply the use of
radiological investigations
in advanced
musculoskeletal
physiotherapy services
7.1 Anticipate and minimise risks associated with
radiological investigations
7.2 Determine the indication for imaging based on
assessment findings and clinical decision-making
rules
7.3 Select the appropriate modality consistently
and liaise to gain authorisation as required
7.4 Convey all required information on the
imaging request consistently
7.5 Interpret plain-film images using a systematic
approach for patients with common and/or
complex conditions, as relevant to the practice
context
 Apply the principles of assessing the risk:benefit ratio of ionising
radiations to decision making
 Consistently question appropriate female patients regarding current
pregnancy/breastfeeding status as indicated
 Determine any previous imaging performed to date, including
appropriateness before requesting investigation
 Apply the indications, advantages and disadvantages, precautions and
contraindications of different imaging modalities to decision making for
a variety of presentations
 Follow the clinical decision-making rules to determine imaging
applicable to specialised clinical setting
 Understand and recognise limitations of imaging protocols from primary
care settings
 Recognise views or special imaging that may be preferred in assisting
diagnosis – for example, impingement views at the shoulder
 Follow the local organisation’s policies and procedures regarding
13
Element
Elements describe the
essential outcome of the
competency standard
Performance criteria
The performance criteria specify the level of the
performance required to demonstrate
achievement of the element
7.6 Identify when input is required from expert
colleagues and act to obtain their involvement
7.7 Meet threshold credentials and/or external
learning and assessment processes set by the
organisation, governing body or state/territory
legislation
Performance cues
Performance cues provide practical examples of what an independent
performer may look like in action
referral and requesting of imaging by physiotherapists
 Describe the recommended imaging pathways for a variety of common
presentations in specialist clinics – for example, upper limb, lower limb
or spinal, as indicated
 Determine when imaging is not indicated and effectively communicate
this to the patient
 Determine when imaging other than plain film may be indicated and
liaise effectively with a consultant / medical specialist regarding this,
ensuring all precautions and contraindications have been identified prior
to discussion
 Include all essential information on the imaging referral consistently:
o
authorising consultant, own name, designated role and contact
detail, as agreed via local policy
o
correct patient information and side
o
clinical findings such as site of injury and mechanism
o
preliminary diagnosis
o
other relevant information, such as previous fracture/injury to
region
 Use a systematic approach to imaging interpretation consistently:
o
routine check of name, date, side and site of injury
o
correct patient positioning, view and exposure
o
ABCS (alignment, bone, cartilage, soft tissue)
o
common sites of injury or pathology
o
common sites for missed injuries
 Interpret plain-film x-rays accurately and consistently and seek expert
opinion when uncertain or when results may be inconclusive
14
Element
Elements describe the
essential outcome of the
competency standard
Performance criteria
The performance criteria specify the level of the
performance required to demonstrate
achievement of the element
Performance cues
Performance cues provide practical examples of what an independent
performer may look like in action
 Demonstrate awareness if common radiological findings that are
incidental or anatomical variants and may not relate to the patient’s
symptomology
 Seek medical input when interpreting imaging such as CT and MRI as
appropriate to the clinical setting
8. Apply the use of
pathology tests in
advanced musculoskeletal
physiotherapy services
(under the direction and
supervision of a
consultant)
8.1 Anticipate and minimise risks associated with
pathology tests
8.2 Determine the indication for pathology testing
based on assessment findings and clinical
decision-making rules and liaise with consultant
and/or GP
8.3 Identify the appropriate test(s) consistently
and act to gain authorisation as required
8.4 Convey all required information to appropriate
personnel when initiating pathology tests
8.5 Interpret routine pathology test results for
patients with common and/or complex conditions,
as relevant to the practice context and in
consultation with expert colleagues when required
8.6 Meet threshold credentials and/or external
learning and assessment processes set by the
organisation, governing body or state/territory
legislation
 Consistently identify patients infected with HIV or other bloodtransmissible virus and notify the staff involved in the procedure about
handling of specimens according to local procedure
 Identify the common indications for pathology testing inclusive of:
o
venous blood collection
o
capillary blood collection (blood glucose)
o
urine collection
 Convey accurate and relevant patient assessment findings to the
consultant to ensure the pathology request form conveys full and
accurate information, for example:
o
the right test is conducted for the right indication for the right
patient
o
clinical details are accurate
o
details of drug therapy that may affect test or interpretation are
included
 Describe procedures and tests to the patient accurately and in a
manner they can understand and consent to
 Ensure suitable location and positions for procedural access
 Interpret a range of pathology tests relevant to the practice context in
consultation with the specialist consultant – for example, blood glucose
testing and full blood count
15
Element
Elements describe the
essential outcome of the
competency standard
Performance criteria
The performance criteria specify the level of the
performance required to demonstrate
achievement of the element
9. Apply the use of
therapeutic medicines in
advanced musculoskeletal
physiotherapy services
(under the direction and
supervision of a
consultant)
9.1 Determine the indication and appropriate
medication requirements from information
obtained from the history taking and clinical
examination, and liaise with relevant health
professionals regarding this
Performance cues
Performance cues provide practical examples of what an independent
performer may look like in action
 Acknowledge and follow the legislative barriers to physiotherapists
prescribing therapeutic medicine, as well as local policy for providing
medicines
 Understand the indications, contraindications, common side effects and
dosage for analgesic, anti-inflammatory and neuropathic pain
medications
 Understand the differences between time-contingent and paincontingent medication use and indications for each
 Acknowledge and understand the challenges of achieving analgesia in
patients with opioid tolerance and substance abuse disorders
 Accurately record patient’s current medication regimen for their
condition and other pre-existing medical conditions, and compliance
with prescribed medication
 Apply the requirements of being a competent prescriber to decision
making within the practice context (refer to NPS competency framework
http://www.nps.org.au/health-professionals/professionaldevelopment/prescribing-competencies-framework)
 Provide the patient with adequate information to ensure safe medicine
use (within the physiotherapist’s scope of practice and legislative
requirements) and ascertain the patient understands prior to discharge
9.2 Demonstrate knowledge of pharmacokinetics,
indications, contraindications and precautions,
adverse effects, interactions, dosage and
administration of medications commonly used to
treat musculoskeletal conditions, applicable to the
practice context
9.3 Apply knowledge of the legal and professional
responsibilities relevant to recommending,
administering, using, supplying and/or prescribing
medicines under the current legislation, as
relevant to the practice context
16
Element
Elements describe the
essential outcome of the
competency standard
Performance criteria
The performance criteria specify the level of the
performance required to demonstrate
achievement of the element
Performance cues
Performance cues provide practical examples of what an independent
performer may look like in action
9.4 Comply with national, state/territory drugs and
poisons legislation
9.5. Identify when input is required from expert
colleagues and act to obtain their involvement
9.6 Apply relevant knowledge of the medicine
involved when recommending and informing
patients of the risks and benefits of use
9.7 Exercise due care including properly
assessing the implications for individual patients
receiving therapeutic medicine, as relevant to the
practice context
9.8 Maintain proper clinical records as they relate
to therapeutic medicine
9.9 Meet threshold credentials and/or external
learning and assessment processes set by the
organisation, governing body and national and
state/territory legislation
10. Apply advanced
clinical decision making
10.1 Synthesise and interpret findings from clinical
assessment and diagnostic tests to confirm the
diagnosis
10.2 Demonstrate well-developed judgement in
implementing and coordinating a patient
management plan that synthesises all relevant
factors
 Identify relevant evidence from subjective or objective examination to
support or refute differential diagnoses, with a particular focus on those
that indicate non-musculoskeletal pathology
 Display an awareness of the diagnostic accuracy of physical tests
performed, and discuss the effect of a positive or negative test finding
on pre/post-test probabilities
 Demonstrate flexible thinking and revisit other subjective or objective
examination findings when presented with new information, either from
the patient or as a result of diagnostic investigations
 Link radiological findings to the presenting complaint, demonstrating
awareness of aberrant pathology, incidental findings, anatomical
variants and normal images
17
Element
Elements describe the
essential outcome of the
competency standard
Performance criteria
The performance criteria specify the level of the
performance required to demonstrate
achievement of the element
Performance cues
Performance cues provide practical examples of what an independent
performer may look like in action
 Consider other physiological measures and their impact on differential
diagnosis
 Interpret the relevance of findings of pathology results and decide on
further assessment or management in conjunction with appropriate
medical staff
 Involve other medical staff to determine appropriate management when
necessary
 Incorporate the patient/caregiver in formulating a management plan
 Identify the appropriate management plan for simple limb fractures, soft
tissue injuries, acute and persistent spinal and peripheral conditions
including neuropathic conditions with consideration of surgical and nonsurgical management options, including discussion with medical
colleagues as necessary
 Determine appropriate musculoskeletal support and provide appropriate
aftercare advice
 Determine appropriate additional diagnostic imaging in line with local
policies/procedures/practice context, in conjunction with medical
colleagues as required
 Refer patients on to other specialist clinics in line with local policies/
procedures/practice context in conjunction with medical colleagues as
required
 Identify precautions and contraindications for medications appropriate
to the patient
10.3 Use finite healthcare resources wisely to
achieve best outcomes
 Modify practice to accommodate changing demands in the availability of
local resources – for example, high demands on radiology and long
elective surgical waiting times
 Educate patients regarding expectations of services that may not be
available, indicated or realistic in outpatient setting – for example, a
patient requesting MRI scan for axial back pain without trial of
conservative management
18
Element
Elements describe the
essential outcome of the
competency standard
Performance criteria
The performance criteria specify the level of the
performance required to demonstrate
achievement of the element
11. Formulate and
11.1 Formulate complex, evidence-based
implement a management/ management plans/interventions as determined
intervention plan
by agreed level of autonomy to act as an agent for
the specialist, relevant to the practice context and
in collaboration with the patient
11.2 Identify when guidance is required from
expert colleagues and act to obtain their
involvement
11.3 Facilitate all prerequisite investigations/
procedures prior to consultation, referral or followup, as relevant to the practice context
11.4 Assess the need for referral or follow-up and
arrange if necessary
11.5 Identify when input to complementary care is
required from other healthcare professionals and
act to obtain their involvement
11.6 Provide appropriate education and advice to
patients with common and/or complex conditions,
as relevant to the practice context
11.7 Conduct a thorough handover to ensure
patient care is maintained
Performance cues
Performance cues provide practical examples of what an independent
performer may look like in action
 Formulate management plans using best available evidence
 Consider the potential benefits and limitations of best evidence in
context of patient
 Ensure available local resources are integrated into decision making –
for example, services available in local area to patient, enhanced
primary care and Medicare
 Involve the patient in formulating management plans
 Seek a medical opinion when serious underlying pathology, urgent
yellow flags or non-musculoskeletal pathology is suspected
 Identify when a management plan extends beyond scope of practice
and engage appropriate assistance and/or handover to medical team
 Engage other health professionals to complement care – for example,
social worker for homelessness, nurse for wound management,
bariatric or pain management services – and ensure patient is
consenting to management plan and is fully aware of referrals
 Liaise with other health professionals to complete WorkCover/sick
certificates
 Communicate with patient’s GP/community services as required
 Provide education and advice to the patient/caregiver, including
diagnosis, treatment plan, self-management strategies (where
indicated), advice when to seek further help, medication usage,
vocational advice, timelines regarding recovery, referrals for ongoing
management and information on local community resources/health
promotion
 Use written information for patients where available
 Confirm patient’s understanding of information provided
 Communicate effectively using written and verbal methods when
handing over patient care
 Ensure handover is given to an appropriate professional
 Ensure patients are informed of the handover
19
Element
Elements describe the
essential outcome of the
competency standard
Performance criteria
The performance criteria specify the level of the
performance required to demonstrate
achievement of the element
12. Monitor and escalate
care
12.1 Monitor the patient response and progress
throughout the intervention using appropriate
visual, verbal and physiological observations
12.2 Identify and respond to atypical situations
that arise when implementing the management
plan/intervention
13. Obtain patient consent 13.1 Explain own activity to the patient as it
specifically relates to the practice context and
check that the patient agrees before proceeding
13.2 Evaluate the patient’s capacity for decision
making and consent
Performance cues
Performance cues provide practical examples of what an independent
performer may look like in action
 Ensure that all appropriate baseline measures, including neuro
examination if appropriate, are recorded initially and at appropriate
intervals with follow-up
 Identify and act on verbal and non-verbal cues that indicate distress,
worsening pain levels or neurological symptoms, and engage with
consultant or GP as indicated
 Recognise difficult and challenging behaviours – for example,
aggression, intoxication or expressed desire to self-harm. Use
appropriate de-escalation strategies and seek involvement of other
team members where required – for example, code grey, security
personnel
 Monitor for side effects of any medications prescribed and inform
relevant staff
 Identify changes to likely differential diagnosis throughout the
assessment and management of patients
 Identify which patients require multidisciplinary input or no longer
require physiotherapy input
 Identify which patients need to be handed over to medical colleagues
for all ongoing care
 Identify signs of worsening systemic function and escalate appropriately
 Identify issues around continuing consent to treatment with involvement
of other colleagues as necessary
 Clearly inform the patient that their care is being managed by a
physiotherapist, and address any issues relating to patient expectation
of being managed by a medical officer
 Educate patient and confirm their understanding of relevant risks and
benefits of investigations and procedures while under the care of the
physiotherapist but not limited to those performed by the
20
Element
Elements describe the
essential outcome of the
competency standard
Performance criteria
The performance criteria specify the level of the
performance required to demonstrate
achievement of the element
13.3 Inform the patient of any additional risks
specific to advanced practice, proposed
treatments and ongoing service delivery, and
confirm their understanding
13.4 Employ strategies for overcoming barriers to
informed consent as relevant to the practice
context
14. Document patient
information
14.1 Document in the patient health record, fully
capturing the entire intervention and consultation
process, addressing areas of risk and consent,
and including any referral or follow-up plans
Performance cues
Performance cues provide practical examples of what an independent
performer may look like in action
physiotherapist
 Consistently identify factors compromising patient’s capacity to consent
– for example, intoxication, shock, patient duress/stress, substance
abuse, culturally and linguistic diversity, mental health conditions and
children (without next of kin)
 Liaise with expert colleagues – for example, the consultant – when
presented with barriers to consent
 Arrange interpreters where indicated
 Consistently include all aspects of the patient’s assessment and
management by the physiotherapist
 Consistently meet standards defined by the local healthcare network
including consent
 Be aware of the effects of common treatment options that may impact
on a patient with diabetes (for example, effect of corticosteroid on blood
sugar levels)
 Demonstrate a working knowledge of local processes for
documentation
 Consistently complete all documentation related to clinic attendance –
for example, referrals and discharge letters
 Consistently meet the standards outlined by APRHA’s code of conduct
for maintaining a health record
Specific to practice context (screening clinics)
15. Implement
management of fractures
and simple joint
reductions (physio ED
review clinic)
15.1 Integrate knowledge of fracture management
principles to assess and manage simple radialhead fractures or clinically suspected fractures
where imaging is negative
 Identify, define and describe fracture patterns and their significance to
management
 Describe the process involved and factors affecting fracture healing
 Describe classification of radial head fractures and associated
management options
 Assess for the possible complications of fractures and associated
injuries for example, neurovascular damage, compartment syndrome,
21
Element
Elements describe the
essential outcome of the
competency standard
Performance criteria
The performance criteria specify the level of the
performance required to demonstrate
achievement of the element
Performance cues
Performance cues provide practical examples of what an independent
performer may look like in action
soft tissue injuries
 Apply the appropriate form of immobilisation where indicated
 Ensure patient can mobilise/function safely prior to discharge
 Confirm the patient understands the diagnosis, treatment plan, selfmanagement strategies (where indicated), advice when to seek further
help, medication usage, vocational advice, timelines re: recovery,
referrals for ongoing management, and information on local community
resources and health promotion
 Arrange appropriate follow-up and referral information
15.2 Identify what fractures require the
involvement of the orthopaedic team and provide
appropriate care until such review occurs
 Identify fractures associated with ligamentous and other soft tissue
injuries that need immediate medical care and act accordingly to
ensure a timely medical review occurs
 Communicate effectively with medical team demonstrating the ability to
describe the fracture from x-ray findings, relevant findings from history
taking and clinical examination
 Ensure adequate imaging has occurred prior to specialist review
15.3 Identify an unstable knee and when
immediate orthopaedic attention is required
 Identify knee pathology signs and symptoms that contribute to an
unstable knee
 Identify which structures contribute to an unstable knee and identify
appropriate management options
 Identify and perform clinical tests to confirm
 Identify radiological criteria for confirmation of unstable knee in
combination with physical assessment
15.4 Identify shoulder pathology of shoulder
dislocation and associated injuries, as well as AC
dislocation, and liaise with orthopaedic team to
ensure optimal management
 Describe typical patterns of shoulder dislocation, the mechanism of
injury, typical structures injured within shoulder and imaging findings
 Describe complications of shoulder dislocation
 Identify and perform physical exam to exclude complications in
particular neurovascular examination
22
Element
Elements describe the
essential outcome of the
competency standard
Performance criteria
The performance criteria specify the level of the
performance required to demonstrate
achievement of the element
Performance cues
Performance cues provide practical examples of what an independent
performer may look like in action




15.5 Demonstrate the ability to safely and
effectively apply musculoskeletal support where
indicated in managing musculoskeletal conditions
Identify and perform appropriate peripheral nerve examination
Identify and perform special tests of instability and labral pathology
Identify the classification system of AC joint injuries
Understand which injuries are managed conservatively and which could
be managed surgically
 Describe and demonstrate in practice the principles for applying
musculoskeletal support (plastering, splints, taping) inclusive of:
o
o
o
o
o
o
o
16. Implement care of
musculoskeletal
conditions in patients with
diabetes
indications for patient consent and compliance
preparation of limb
positioning of limb
application
precautions and warnings
aftercare management and patient education
 referrals and follow-up
removal of musculoskeletal support
16.1 Modify routine musculoskeletal assessment in  State the normal blood glucose range
recognition of a patient’s diabetic condition, as
 Identify situations when blood glucose should be tested
relevant to the practice context
 Interpret the results of blood glucose testing and report readings
outside the acceptable range to the appropriate person
 Identify situations where testing for ketones is appropriate
16.2 Modify routine musculoskeletal interventions
 Recognise the signs of hypoglycaemia or hyperglycaemia and act in a
in recognition of a patient’s diabetic condition, as
timely way to involve nursing and medical staff
relevant to the practice context
 Demonstrate a basic knowledge of the types of oral antihyperglycaemic agents and how they work
16.3 Provide patients with diabetic conditions with  Demonstrate a basic knowledge of insulin and GLP-1 receptor agonists
information relevant to altering their health
– for example, drug type, action and side-effects
behaviours and improving their health status
 Know the appropriate referral system to the diabetes specialist team,
23
Element
Elements describe the
essential outcome of the
competency standard
Performance criteria
The performance criteria specify the level of the
performance required to demonstrate
achievement of the element
Performance cues
Performance cues provide practical examples of what an independent
performer may look like in action
16.4 Identify when input is required from expert
and use where appropriate
colleagues to assess and manage musculoskeletal  Be familiar with the treatment regimen and device or delivery systems
conditions in patients with diabetes and act to
for a person with diabetes
obtain their involvement
 Be aware of policies relating to fasting in people with diabetes
undergoing surgical or investigative procedures, or a prolonged stay in
16.5 Apply evidence-based practice to managing
the ED
musculoskeletal condition in patients with diabetes  Recognise the need for and carry out foot screening for people with
diabetes, inclusive of a thorough neurovascular assessment
 Demonstrate awareness of complications and prevention of neuropathy
 Describe measures to prevent tissue damage in people with diabetes
 Demonstrate an awareness that all people with diabetes are at risk of
nephropathy and the implications of this on medication use
 Demonstrate an awareness that all people with diabetes are at risk of
retinopathy and consider the impact of this in the management and
follow-up plan
 Ensure health professionals involved in care of the patient’s diabetes
are informed of diagnosis, changes to medications, management and
follow-up plan
 Encourage people with diabetes to participate in safe and healthy,
active lifestyle behaviours as part of their recovery process
17. Develop and
implement a management
plan for patients
presenting with spinal
pain
17.1 Perform appropriate spinal assessment with
appropriate subjective examination, appropriate
objective examination and advanced clinical
reasoning to offer appropriate advice to patients
and carers
17.2 Demonstrate understanding of different
surgical management for spinal pain, typical
presentations, indications for surgery, risks and
 Demonstrate an understanding of the natural history of acute and
chronic spinal pain presentations and the likely prognosis
 Demonstrate an advanced understanding of when surgery is indicated
in managing musculoskeletal spinal pain
 Demonstrate an advanced understanding of the evidence base for
physiotherapy and exercise in managing acute and persistent spinal
pain
 Conduct an appropriate subjective examination that is focused on
clearing spinal red flags and gathering appropriate information to help
with differential diagnosis
24
Element
Elements describe the
essential outcome of the
competency standard
Performance criteria
The performance criteria specify the level of the
performance required to demonstrate
achievement of the element
Performance cues
Performance cues provide practical examples of what an independent
performer may look like in action
proposed benefits
 Perform a musculoskeletal examination with appropriate testing of
active and passive range of movement, repeated movement,
ligamentous structures, muscle strength, special tests, palpatory exam
and functional abilities as appropriate, to further confirm or refute
differential diagnoses
 Identify patients presenting with non-mechanical symptoms requiring
the review of another medical specialty, such as neurology or
rheumatology
 Demonstrate advanced clinical reasoning in analysing findings
 Use a problem list to construct a goal-orientated management plan that
the patient understands and consents to
 Clearly identify and prioritise patients presenting with urgent surgical
requirements and/or pain management requirements, and engage the
consultant to expedite further evaluation and management
 Perform a neurological examination with appropriate testing of reflexes,
sensation, power, tone and neuro-dynamics
 Demonstrate ability to synthesise findings and document what is the
likely underlying pathology
 Consistently document all areas tested, including positive and negative
findings
 Demonstrate an advanced understanding of the evidence base for
other conservative therapies, such as spinal injections and possible
risks and contraindications
 List the types of spinal injections and what types of drugs are
administered
 Demonstrate an awareness of anticoagulant medications and list
possible complications following a spinal injection, including being on
anticoagulant
 Document how risk is minimised when patient is scheduled to have a
spinal injection
17.3 Perform sufficient neurological examination
that incorporates upper motor neurone and lower
motor neurone and peripheral nerve examinations
with consistency in documentation standard
17.4 Identify which patients may respond to
injections and have an understanding of the
different types of injections, their associated risks
and efficacy, and be aware when a patient is on
anticoagulant medication
25
Element
Elements describe the
essential outcome of the
competency standard
Performance criteria
The performance criteria specify the level of the
performance required to demonstrate
achievement of the element
18. Develop and
implement a management
plan for patients
presenting with limb pain
18.1 Perform appropriate peripheral assessment
with appropriate subjective examination,
appropriate objective examination and advanced
clinical reasoning to offer appropriate advice to
patients and carers
Performance cues
Performance cues provide practical examples of what an independent
performer may look like in action
 Demonstrate an understanding of the natural history of acute and
chronic limb-pain presentations and the likely prognosis
 Demonstrate an advanced understanding of when surgery is indicated
in managing musculoskeletal limb pain
 Demonstrate an advanced understanding of the evidence base for
physiotherapy and exercise in managing acute and persistent limb pain
18.2 Perform an adequate knee examination, both  Demonstrate an advanced understanding of the evidence base for
subjective and objective, in order to direct
other conservative therapies, such as local anaesthetic blocks,
conservative management and prioritise the knee
cortisone injections
pathologies that require more urgent surgical
 Clearly identify and prioritise patients presenting with urgent surgical
intervention
requirements and/or pain management requirements, and engage the
consultant to expedite further evaluation and management
18.3 Perform an adequate shoulder examination,
 Conduct an appropriate subjective examination that is focused on
both subjective and objective, in order to determine
clearing red flags and gathering appropriate information to help with
which shoulder pathologies require conservative
differential diagnosis
versus surgical management and in which

Identify patients presenting with non-mechanical symptoms requiring
timeframes
the review of another medical specialty, such as neurology or
rheumatology
 Demonstrate advanced clinical reasoning in analysing findings
 Use a problem list to construct a goal-oriented management plan that
the patient understands and consents to
 Consistently document all areas tested, including positive and negative
findings
 Perform a musculoskeletal examination with appropriate testing of
active and passive range of movement, repeated movement,
ligamentous structures, muscle strength, special tests, palpatory exam
and functional abilities as appropriate, to further confirm or refute
differential diagnoses
 Demonstrate an understanding of the definition of knee instability
 Demonstrate an understanding of surgical versus conservative best
practice guidelines and the timely nature of intervention
 Demonstrate an understanding of imaging guidelines that support best
26
Element
Elements describe the
essential outcome of the
competency standard
Performance criteria
The performance criteria specify the level of the
performance required to demonstrate
achievement of the element
Performance cues
Performance cues provide practical examples of what an independent
performer may look like in action
practice
 Demonstrate an understanding of the type of immobilisation required
 Perform adequate assessment techniques to assess knee instability
 Perform adequate assessment to differentiate meniscal from patellafemoral joint pathologies
 Demonstrate an understanding of meniscal debridement versus repair
with associated surgical options, indications for each and the evidence
base for efficacy
 Demonstrate an understanding of the recurrent patella-femoral joint
dislocation, conservative and surgical management options and
evidence base for each
 Perform a shoulder examination, having an awareness of adequate
impingement tests, instability tests and muscle strength tests with their
associated sensitivity/specificity, to formulate an accurate diagnosis
 Demonstrate an understanding of surgical versus conservative best
practice guidelines and the timely nature of intervention, taking into
account natural history of conditions, such as shoulder dislocation,
rotator cuff tears, frozen shoulder
 Demonstrate an understanding of imaging guidelines that support best
practice
 Perform adequate assessment to be able to specify physiotherapy
treatment approaches that may be more appropriate in managing
specific cases
 Demonstrate an understanding of injections at the shoulder, what drug
is administered, principles of efficacy and how frequently they can be
administered if effective, articulating the risks and evidence base for
efficacy
19. Implement care of
acute and persistent pain
conditions
19.1 Identify the complexity, multidimensional and
individual nature of the pain experience
19.2 Identify the impact of pain on society
 Demonstrate the understanding that function, activity level and disability
are associated with, but are not the same as, pain
 Identify the substantial variability in response to actual tissue damage
27
Element
Elements describe the
essential outcome of the
competency standard
Performance criteria
The performance criteria specify the level of the
performance required to demonstrate
achievement of the element
Performance cues
Performance cues provide practical examples of what an independent
performer may look like in action
19.3 Formulate a preliminary hypothesis,
differential diagnoses and patient-centred
management plan

19.4 Ensure that management plans are designed
to optimise patient compliance/treatment
adherence









or potential tissue damage, as reflected in the modest correlations
among physical damage, pain and disability for acute, progressive and
chronic pain
Demonstrate knowledge of the basic neurochemical and neurologic
mechanism through which emotion, cognition and behaviour influence
each other and are influenced by physiology
Demonstrate an understanding of the various emotional reactions to
actual or potential tissue damage, including anxiety, fear, depression
and anger
Demonstrate the knowledge that anticipatory anxiety, distress and fear
may exacerbate pain or predict pain severity
Demonstrate an understanding of the major interactions between
cognitive appraisal and affective reactions – for example, the role of
catastrophising, helplessness and other maladaptive patterns of
thinking, or the consequence of self-efficacy and personal control
Demonstrate empathic and compassionate communication
Demonstrate an understanding of how cultural, institutional, societal
and regulatory influences affect the assessment and management of
pain
Demonstrate the knowledge that there are cultural, environmental and
racial variations in pain experience and expression, and in healthcare
seeking and treatment
Demonstrate the knowledge that pain behaviours and complaints are
best understood in the context of social transactions among the
individual, spouse, employers and health professionals, and in the
context of community, governmental or legal procedures
Demonstrate an understanding of the potential role of the family in
promoting illness or well behaviour
Demonstrate an awareness of the significance of stress and trauma –
for example, family violence, sexual abuse and interpersonal
relationship discord – as predisposing, exacerbating or maintaining
factors in pain complaints and disability
28
Element
Elements describe the
essential outcome of the
competency standard
Performance criteria
The performance criteria specify the level of the
performance required to demonstrate
achievement of the element
Performance cues
Performance cues provide practical examples of what an independent
performer may look like in action
 Demonstrate an awareness that chronic pain patients can present with
signs and symptoms that are incongruent with clinical expectations
based on anatomical and physiological knowledge
 Identify that malingering and deception are possible, and identify
factors that increase the likelihood, as well as limitations in our
capacities to accurately assess malingering
 Be able to develop a treatment plan based on the benefits and risks of
available treatments
 Demonstrate an understanding of the role of the clinician, including
acting as an advocate to assist the patient to meet treatment goals
 Demonstrate familiarity with how individual differences in both patients
and health professionals affect adherence to treatment
recommendations
 Demonstrate an understanding of how expectations, coping, cultural
factors and environmental factors influence disability, treatment
outcome and maintenance of treatment effects
20. Implement appropriate
care of acute and
persistent pain conditions
in patients who have
psychological conditions,
including anxiety,
depression and posttraumatic stress disorder
20.1 Exercise due care in managing patients with
acute and chronic pain with psychological
comorbidities, including on referral of patients with
poorly managed psychological symptoms or who
are considered at risk of self-harm
20.2 Demonstrate knowledge of the common
psychological comorbidities associated with acute
and persistent pain
 Demonstrate awareness that pain and depression, as well as anxiety,
are associated with each other
 Demonstrate the knowledge that chronic pain is not masked
depression, nor is there evidence for the pain-prone personality
disorder
 Demonstrate the knowledge that depression in chronic pain patients is
more likely to be a consequence than a cause of chronic pain but that
psychosocial factors may increase the risk for the development of
chronic pain, particularly anxiety, catastrophising, alcohol or other
substance disorders, and occupational impairment
 Demonstrate the knowledge that depression may be a predictor of pain
severity, pain behaviour, disability or adherence to pain treatment, and
that the presence of pain may be a predictor of depression severity;
however, be aware that these are associations, not causal statements
 Identify that early intervention is increasingly seen as central to the
29
Element
Elements describe the
essential outcome of the
competency standard
Performance criteria
The performance criteria specify the level of the
performance required to demonstrate
achievement of the element
Performance cues
Performance cues provide practical examples of what an independent
performer may look like in action
prevention of long-term disability
 Evaluate psychosocial risk factors that influence the onset and
maintenance of disability and understand the interventions for their
management
30
Learning needs analysis Part A and B: screening and ED soft tissue review clinics
The Learning needs analysis is a self-assessment using the Competency standard self-assessment tool (Part A) and the underpinning Knowledge and skills
self-assessment tool (Part B). Part B includes an extensive list that varies from having a basic awareness to advanced knowledge of the different skills and
knowledge an advanced musculoskeletal physiotherapist may require. It should be completed with Part A prior to developing the Learning and assessment
plan.
Both Part A and B of the Learning needs analysis should first be completed by the individual (approximately no more than ½ hour should be spent doing
this – it is a tool designed to identify gaps in knowledge). Part A and B are then reviewed jointly with the physiotherapists and clinical lead or mentor. The
key areas for development to be addressed in the learning program should be prioritised with help from the clinical lead or mentor according to relevance to
the role and most common conditions that are likely to present to the organisation. The non-clinical time available to the physiotherapist also needs to be
considered when prioritising what areas need to be addressed first.
It is not expected that ALL of what is listed in Part B needs to be addressed in order to achieve competency. Part B is merely a tool to help identify
what the physiotherapist does not know and direct learning accordingly. A tailored Learning and assessment plan should then be developed to direct the use
of the learning modules (accessible on the Victorian Department of Health website).
Additionally, the Learning needs analysis Part A and B, once completed, can also be used as evidence as having met the performance criteria (2.1, 3.1–3) of
the competency standard by the method of self-assessment.
31
Competency standard self-assessment tool – Part A of the Learning needs analysis: screening and ed soft
tissue review clinic
Clinicians use self-assessment to help them reflect meaningfully and identify both their strengths and their own learning needs. This allows tailoring of the
training and assessment program to meet that identified learning need.
The Competency standard self-assessment tool is a self- assessment against the elements and performance criteria listed in the competency standard. It
also is Part A of the Learning needs analysis. If needed refer to the performance cues on the competency standard to assist with this self-assessment
process.
ROLE
RELEVAN
CE
work role
Candidate’s
Date of selfname:
assessment:
INDICATE YOUR LEVEL OF CONFIDENCE AGAINST THE FOLLOWING PERFORMANCE CRITERIA
1. I require training and development in most or all of this area
2. I require further training in some aspects of this area
3. I am confident I already do this competently
ELEMENTS AND PERFORMANCE CRITERIA
Confidence
o
Refer to the competency standard for further details
rating scale
o
1
2
3
If 1 or 2 on the confidence rating scale
document action plan
If 3 on the confidence rating scale
provide/document evidence of
competency
PROFESSIONAL BEHAVIOURS
1. Operate within scope of practice
1.1 Identify and act within own knowledge base and scope of practice
1.2 Work towards the full extent of the role
2. Display accountability
2.1 Take responsibility for own actions as it applies to the practice context
LIFELONG LEARNING
3. Demonstrate a commitment to lifelong learning
3.1 Engage in lifelong learning practices to maintain and extend professional
competence
3.2 Identify own professional development needs, and implement strategies for
32
achieving them
3.3 Engage in both self-directed and practice-based learning
3.4 Reflect on clinical practice to identify strengths and areas requiring further
development
3.5 Formulate learning objectives and strategies for addressing own limitations
COMMUNICATION
4. Communicate with colleagues
4.1 Use concise, systematic communication at the appropriate level when
conversing with a range of colleagues in the practice context
4.2 Present all relevant information to expert colleagues when acting to obtain
their involvement
PROVISION AND COORDINATION OF CARE
5. Evaluate referrals
5.1 Discern patients who are appropriate for advanced physiotherapy
management in accordance with individual strengths or limitations, any legal or
organisational restrictions on practice, the environment, the patient profile/needs
and within defined work roles
5.2 Discern patients who are appropriate for management in a shared care
arrangement in accordance with individual strengths or limitations, any legal or
organisational restrictions on practice, the environment, the patient profile/needs
and within defined work roles
5.3 Defer patient referrals to relevant professionals (including other
physiotherapists) when limitations of skill or job role prevent the client’s needs
from being adequately addressed, or when indicated by local triage procedure
5.4 Prioritise referrals based on patient profile/need, organisational procedure or
targets and any local factors
5.5 Communicate action taken on referrals using established organisational
processes
6. Perform health assessment/examination
6.1 Design and perform an individualised, culturally appropriate and effective
patient interview with common and/or complex conditions/presentations
6.2 Formulate a preliminary hypothesis and differential diagnoses for a patient
33
with common and/or complex conditions, as relevant to the practice context
6.3 Perform complex modifications to routine musculoskeletal assessment in
recognition of factors that may impact on the process such as the patient
profile/needs and the practice context
6.4 Design and conduct an individualised, culturally appropriate and effective
clinical assessment that:
 is systems-based
 includes relevant clinical tests
 selects and measures relevant health indicators
 substantiates the provisional diagnosis
6.5 Identify when input is required from expert colleagues and act to obtain their
involvement
6.6 Ensure all ‘red flags’ are identified in the assessment process, link ‘red flags’
to diagnoses not to be missed and take appropriate action in a timely manner
6.7 Ensure ‘yellow flags’ are identified in the assessment process and take
appropriate action in a timely manner
7. Apply the use of radiological investigations
7.1 Anticipate and minimise risks associated with radiological investigations
7.2 Determine the indication for imaging based on assessment findings and
clinical decision-making rules
7.3 Select the appropriate modality consistently and act to gain authorisation as
required
7.4 Convey all required information on the imaging request consistently
7.5 Interpret plain-film radiological images using a systematic approach for
patients with common and/or complex conditions, as relevant to the practice
context
7.6 Identify when input is required from expert colleagues and act to obtain their
involvement
7.7 Meet threshold credentials and/or external learning and assessment
processes set by the organisation, governing body or state/territory legislation
8. Apply the use pathology tests in advanced musculoskeletal physiotherapy (under the direction and supervision of a consultant)
8.1 Anticipate and minimise risks associated with pathology tests
34
8.2 Determine the indication for pathology testing based on assessment findings
and clinical decision-making rules with consultant and/or GP
8.3 Identify the appropriate test(s) consistently and act to gain authorisation as
required
8.4 Convey all required information to appropriate personnel when initiating
pathology tests
8.5 Interpret pathology test results for patients with common and/or complex
conditions, as relevant to the practice context and in consultation with expert
colleagues when required
8.6 Meet threshold credentials and/or external learning and assessment
processes set by the organisation, governing body or state/territory legislation
9. Use therapeutic medicines in advanced musculoskeletal physiotherapy (under the direction and supervision of a consultant)
9.1 Determine the indication and appropriate medication requirements from
information obtained from the history taking and clinical examination and liaise
with relevant health professionals regarding this
9.2 Demonstrate knowledge of pharmacokinetics, indications, contraindications
and precautions, adverse effects, interactions, dosage and administration of
medications commonly used to treat musculoskeletal conditions, applicable to the
practice context
9.3 Apply knowledge of the legal and professional responsibilities relevant to
recommending, administering, using, supplying and/or prescribing medicines
under the current legislation, as relevant to the practice context
9.4 Comply with national and state/territory drugs and poisons legislation
9.5 Identify when input is required from expert colleagues and act to obtain their
involvement
9.6 Apply relevant knowledge of the medicine involved when recommending and
informing patients of the risks and benefits of use
9.7 Exercise due care including properly assessing the implications for individual
patients receiving therapeutic medicine, as relevant to the practice context
9.8 Maintain proper clinical records as they relate to therapeutic medicine
9.9 Meet threshold credentials and/or external learning and assessment
processes set by the organisation, governing body and national and state/territory
legislation
35
10. Advanced clinical decision making
10.1 Synthesise and interpret findings from clinical assessment and diagnostic
tests to confirm the diagnosis
10.2 Demonstrate well-developed judgement in implementing and coordinating a
patient management plan that synthesises all relevant factors
10.3 Use finite healthcare resources wisely to achieve best outcomes
11. Formulate and implement a management/intervention plan
11.1 Formulate complex, evidence-based management plans/interventions that
are relevant to the practice context and in collaboration with the patient, as
determined by agreed level of autonomy to act as an agent for the specialist
11.2 Identify when guidance is required from expert colleagues and act to obtain
their involvement
11.3 Facilitate all prerequisite investigations/procedures prior to consultation,
referral or follow-up, as relevant to the practice context
11.4 Assess the need for referral or follow-up and arrange if necessary
11.5 Identify when input to complement care is required from other health
professionals and act to obtain their involvement
11.6 Provide appropriate education and advice to patients with common and/or
complex conditions, as relevant to the practice context
11.7 Conduct a thorough handover to ensure patient care is maintained
12. Monitoring and escalation
12.1 Monitor the patient response and progress throughout the intervention using
appropriate visual, verbal and physiological observations
12.2 Identify and respond to atypical situations that arise when implementing the
management plan/intervention
13. Obtain patient consent
13.1 Explain own activity to the patient as it specifically relates to the practice
context and check that the patient agrees before proceeding
13.2 Consider the patient’s capacity for decision making and consent
13.3 Inform the patient of any additional risks specific to advanced practice
proposed treatments and ongoing service delivery and confirm their
understanding
13.4 Employ strategies for overcoming barriers to informed consent as relevant to
36
the practice context
14. Document patient information
14.1 Document in the patient health record, fully capturing the entire intervention,
consultation process, addressing areas of risk and consent and including any
referral or follow-up plans
ADDITIONAL ADVANCED PRACTICE CLINICAL TASKS SPECIFIC TO PRACTICE CONTEXT
15. Implement management of fractures and simple joint reductions (physio ED review clinic)
15.1 Integrate knowledge of fracture management principles to assess and
manage simple radial head fractures or clinically suspected fractures where
imaging is negative
15.2 Identify what fractures require the involvement of the orthopaedic team and
provides appropriate care until such review occurs
15.3 Identify the unstable knee and recognises when immediate orthopaedic
attention is required
15.4 Identify shoulder pathology of shoulder dislocation and associated injuries as
well as AC dislocation and liaises with orthopaedic team to ensure optimal
management
15.5 Demonstrate the ability to safely and effectively apply musculoskeletal
support where indicated in managing musculoskeletal conditions
16. Implement care of musculoskeletal conditions in patients with diabetes
16.1 Modify routine musculoskeletal assessment in recognition of a patient’s
diabetic condition, as relevant to the practice context
16.2 Modify routine musculoskeletal interventions in recognition of a patient’s
diabetic condition, as relevant to the practice context
16.3 Provide patients with diabetic conditions with information relevant to
altering their health behaviours and improving their health status
16.4 Identify when input is required from expert colleagues to assess and
manage musculoskeletal conditions in patients with diabetes and act to obtain
their involvement
16.5 Apply evidence-based practice to managing musculoskeletal condition in
patients with diabetes
17. Develop and implement a management plan for patients presenting with spinal pain
17.1 Perform appropriate spinal assessment with appropriate subjective
37
examination, appropriate objective examination and advanced clinical reasoning
to offer appropriate advice to patients and carers
17.2 Perform sufficient neurological examination that incorporates upper motor
neurone and lower motor neurone and peripheral nerve examinations with
consistency in documentation standard
17.3 Identify which patients may respond to injections and have an understanding
of the different types of injections, their associated risks and efficacy, and to be
wary of advice of when patient is on an anticoagulant medication
17.4 Demonstrate understanding of different surgical management for spinal
pain, the typical presentations, indications for surgery, risks and proposed
benefits
18. Develop and implement a management plan for patients presenting with limb pain
18.1 Perform appropriate peripheral assessment with appropriate subjective
examination, appropriate objective examination and advanced clinical reasoning
to offer appropriate advice to patients and carers
18.2 Perform an adequate knee examination both subjective and objective in
order to prioritise the knee pathologies that require more urgent surgical
intervention
18.3 Perform an adequate shoulder examination both subjective and objective in
order to determine which shoulder instabilities require conservative versus
surgical management and in which timeframes
19. Implement care of acute and persistent pain conditions
19.1 Identify the complexity, multidimensional and individual nature of the pain
experience
19.2 Identify the impact of pain on society
19.3 Formulate a preliminary hypothesis, differential diagnoses and patientcentred management plan
19.4 Ensure management plans are designed to optimise patient compliance /
treatment adherence
20. Implement appropriate care of acute and persistent pain conditions in patients who have psychological conditions including anxiety, depression, and posttraumatic stress disorder
38
20.1 Exercise due care in managing patients with acute and chronic pain with
psychological comorbidities including on referral of patients with poorly managed
psychological symptoms or considered at risk of self-harm
20.2 Demonstrate knowledge of the common psychological comorbidities
associated with acute and persistent pain
Identified learning needs, action plan and timeframe
39
Knowledge and skills self-assessment – Part B of the Learning needs analysis: screening and ED soft tissue
review clinics
This Learning needs analysis has been modified and adapted with written permission from Symes G 2009, Resource manual and competencies for extended
musculoskeletal roles: chartered physiotherapists with an extended scope of practice, Scotland.
Candidate’s name:
Date of self-assessment:
ROLE
RELEVANCE
INDICATE YOUR LEVEL OF CONFIDENCE AGAINST THE FOLLOWING PERFORMANCE CRITERIA
1. I require training and development in most or all of this area
2. I require further training in some aspects of this area
3. I am confident I already do this competently
Confidence rating
Underpinning skills and knowledge
scale
1
2
Learning strategies
3
1. Musculoskeletal presentations
Background knowledge
The advanced
musculoskeletal
physiotherapist (AMP) has
advanced knowledge in:

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History taking
The AMP is able to obtain
an accurate clinical history
from patient’s presenting


Anatomy of the neuromusculoskeletal systems
Surface anatomy
Neurovascular supply
Functional anatomy
Physiology of the neuromusculoskeletal
systems
Biomechanics of the neuromusculoskeletal
systems
Pain mechanisms
Presenting complaint
Chronological relevant sequence of events and
symptoms
40
with signs and symptoms
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The AMP identifies the
following:
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Mechanism of injury and associated questions
relating to this – for example, falls, HS, gait
aids, protective posturing
Severity, irritability and nature of problem
Current and past medications
Past history of condition
Past treatments and efficacy including external
medical consults
Compliance and adherence to proposed
treatment regimens
Belief system about recovery of condition
Patient expectations of current consultation
Medical history using a systems-based
approach
Special questions as indicated: pregnancy,
spinal red flags, medical red flags
Family history
Personal, work and social history
Hand dominance – musicians, sportspeople,
etc.
Alcohol, smoking, drug taking, sexual history if
relevant (PID)
The likely source of symptoms
The presenting complaint is referred (spinal or
visceral) or of non-musculoskeletal origin
If pain is the main feature then the likely
dominant pain mechanism
Red flags – the symptoms indicate possible
serious pathology such as tumour, fracture,
infection or cauda equina
Yellow flags – psychosocial factors are
exacerbating the presenting complaint
41


Clinical assessment
To perform an accurate
clinical assessment of
patients, the AMP describes
accurately, and includes the
following:
Blue flags – psychosocial factors related to the
workplace are contributing to symptoms
A problem list that priorities main issues for the
patient
Observation of posture and any associated spinal
problem, muscle wasting, skin integrity, absence or
presence of deformity, swelling or protective
posturing
Conducts a baseline assessment (inclusive of vital
signs if relevant)
Conducts a neurovascular assessment where
indicated – inclusive of peripheral nerve assessment
and/or thorough neurological assessment
The AMP is capable of
describing and performing
additional tests as
appropriate and relevant to
the practice context, for
example:
Examination techniques as appropriate, for
example:
 Palpation
 Functional tests
 Range of motion tests
 Muscle strength tests
 Special tests as indicated
SHOULDER
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Hawkins-Kennedy impingement test
Neer’s sign and test
Yocum’s test
Jobe’s test
O’Brien’s test
Crank test
Belly press test
Gerber’s lift-off test
42
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Apprehension tests
Drawer tests
Relocation tests
Sulcus sign
Reflexes
Thoracic outlet tests
Neurodynamic tests
ELBOW
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
Thoracic outlet tests
Upper limb tension tests
Tennis elbow (Cozen’s test)
Mill’s test
Lateral epicondylalgia test for extensor
digitorum
Tinel’s sign for ulnar nerve
Pinch grip test for the anterior interosseus nerve
Collateral ligament varus/valgus stress test
W RIST AND HAND
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Reflexes
Thoracic outlet tests
Upper limb tension tests
Finkelstein’s test
Tinel’s test
Phalen’s test
Watson’s (scaphoid shift or radial stress test)
Triangular fibrocartilage complex (TFCC) test
(ulnar grind)
Resisted active finger extension with wrist in
flexion
Piano key test
Pinch test (scaphoid)
43

Axial compression through thumb (scaphoid)
HIP
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Straight leg raise
Femoral nerve stretch test
Faber (Patrick’s/Figure 4) test
Sacroiliac joint (SI) pain provocation tests
Trendelenburg’s test
Leg length test
Thomas test
Rectus femoris test
Ober’s test
Hamstring contracture test
Sign of the buttock (straight leg raising) test
Squeeze test
KNEE
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Lachman’s test
Joint line palpation
Anterior and posterior drawer
Medial collateral ligament (MCL) or lateral
collateral ligament (LCL) tests
Pivot shift test
Tibial sag sign
McMurray’s test
Loomer’s (dial) test for posterolateral instability
Patella tests – for example,
o Waldron’s test
o McConnell’s critical test
o Passive patellar tilt
o Lateral pull test
o Zohler’s sign
o Frund’s sign
44
o
o
o
o
Patella inhibition test
tracking test
flexion test
Sage sign
FOOT AND ANKLE
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Talar rock
Gait analysis
Hubscher’s (Jack test)
Tinel’s test
Tibialis posterior tests
Windlass test
Mulder’s test
Neurodynamic tests
SPINE
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Upper and lower limb reflexes
Babinski sign
Straight leg raise, active and passive
Femoral nerve stretch test
Neurodynamic tests
Thoracic outlet test
Froment’s sign
Cranial nerve tests
Hip tests
SI pain provocation tests
Segmental instability test
One-leg lumbar extension test
Spurling’s test
Coordination tests
Tests for clonus and upper motor neurone
lesions (UMNL)
45
Investigations
The AMP is aware of the
role, indications, risks and
clinical decision pathways
related to investigations for
the diagnosis and
management of the above
disorders, that is:


Blood tests
Biochemistry – urine analysis and joint
aspirations
 X-rays
 MRI
 CT
 Nerve conduction studies (NCS)
 Ultrasound
The AMP is also capable of interpreting
investigations (plain films, blood tests, and urine
tests) in order to assist in the diagnosis and/or
management of the disorders stated above
The AMP is also able to identify the point at which
referral for a secondary care opinion is appropriate,
if applicable
Differential diagnosis
The AMP shows awareness
of and can identify the
following differential
diagnoses:

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Referred pain from visceral organs inclusive of
cardiac presentations
Infection
Malignancy and tumour
Osteomyelitis
Rheumatological conditions
DVT, thrombosis
SHOULDER

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Thoracic outlet syndrome
Brachial plexus neuritis
Parsonage-Turner syndrome
Neuralgic amyotrophy
Suprascapular nerve entrapment
46


Long thoracic nerve injury
Polymyalgia rheumatica
ELBOW
 Chronic impingement of radial and/or posterior
interosseus nerve
 Irritation of the articular branches of the radial
nerve
 Traumatic periostitis of the lateral epicondyle
 Calcific tendinopathy
 Chondromalacia of the radial head and
capitellum
 Psoriatic arthropathy
W RIST AND HAND
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Intersection syndrome
CRPS
Aneurysmal bone cysts
Pigmented villonodular synovitis
(PVNS)
Inflammatory arthropathies
Gout related tophi
Rheumatoid arthritis (RA)
HIP

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Short-leg syndrome
Gynaecological and pelvic disorders
Hernia
KNEE
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Osteochondromas
Ollier’s disease
Hip lesions (referred)
Monoarticular arthritis/synovitis
47
FOOT AND ANKLE

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
Monoarticular arthritis/synovitis
Charcot-Marie-Tooth disease
Peripheral neuropathy
SPINE
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Pyrogenic and TB infections
UMNL
Vascular/metabolic/visceral
Paget’s disease
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Sprengel’s shoulder
Panner’s disease
Radial club hand
Polydactyly
Syndactyly
Hip dysplasia
Lateral femoral dysplasia
Endochondroma or osteochondroma
Tarsal coalition
Anomalous peroneal tendon
Congenital scoliosis
Spina bifida occulta
Talipes equinovarus
Cervical torticollis
Slipped upper femoral epiphysis (SUFE)
Hip dysplasias and congenital dislocation of the
hip (CDH)
Congenital problems
The AMP is aware of the
following:
48
Management
The AMP is able to:
Diagnose and formulate a
management plan for the
following musculoskeletal
conditions:

Make a sound diagnosis of the clinical condition
based upon the above history, examination and
investigations

Identify conditions that are outside of scope of
practice and need to be managed or referred to
a doctor, specialist, other health professionals
or admission to hospital
SHOULDER
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Fracture
o
o
clavicle, scapula,
humerus–neck/shaft/greater
tuberosity
Dislocations and subluxation
o humerus (anterior/posterior/inferior )
o acromioclavicular
o sternoclavicular
Rotator cuff degeneration
Rotator cuff tears (acute vs chronic), partial
thickness tears, full thickness tears, full
thickness with retraction
Calcific tendinitis
Adhesive capsulitis and recalcitrant condition
Acromioclavicular joint injuries
Sternoclavicular joint injuries
Tendinopathy of the rotator cuff
Subcoracoid, subacromial and glenohumeral
impingement
Biceps ruptures
Osteoarthritis
ELBOW

Fracture and dislocations
o radial head and neck
49
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o olecranon, coronoid, capitellum
o distal humerus
o epicondylar
o supracondylar humerus
Lateral and medial tendinopathy
Loose bodies / osteochondritis dissecans
(OCD)
Osteoarthritis
Bursitis
Extensor tenosynovitis
Ligamentous / soft tissue injuries
W RIST AND HAND
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Fracture and dislocation
o distal radius and/or ulna
o carpals
o metacarpals
o phalanges
Osteoarthritis of the wrist, carpus and
metacarpophalangeal (MCP) joints
Tenosynovitis of thumb, flexors, extensors
Kienböck’s disease
Radio-carpal joint injury
Radio-ulnar joint injury
Carpometacarpal (CMC) joint injury
Scapho-lunate injury
Peri-lunate injury disruption
Mallet finger
Boutonniere deformity
Swan neck deformity
Volar plate injury
Tendon injury – FDP, FPS, EPL, EPB
Sequelae of fractures:
Non-union/malunion fractures of the scaphoid,
hamate, pisiform, triquetral:
Tendinopathies:
o extensor carpi ulnaris
50
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o flexor carpi ulnaris
Neurological pathologies or similar:
o carpal tunnel syndrome
o entrapment of the ulnar nerve in
Guyon’s canal
o neuritis of the dorsal sensory branch of
the ulnar nerve
Dorsal impingement syndromes:
o distal radius stress fractures
o scaphoid stress fractures
o avascular necrosis of the capitate
o ulnar carpal abutment
o dorsal impingement
o occult dorsal ganglion
Wrist complex instability:
o scapho-lunate ligament dissociation
o dorsiflexion instability (DISI)
o palmar flexion instability (VISI)
o scaphoid lunate advanced collapse
(SLAC)
o ulnar translocation
o dorsal subluxation
o TFCC injuries
HIP
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Fracture
o neck of femur
o avulsion
o acetabular
o stress fractures (femoral neck, femoral
shaft, inferior pubic rami, sacrum)
Degenerative joint disease
Labral tears
Femoroacetabular impingement (FAI)
Trochanteric bursitis
Sacroiliac joint problems
Avascular joint problems
CDH/Perthes’
51
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SUFE
Osteitis pubis
Lumbar spine and sacroiliac disorders
Occult hernias (conjoint tendon tears)
Groin disruption (‘Gilmore’s groin’)
Nerve entrapment – for example, ilioinguinal
genitofemoral, lateral femoral cutaneous
Bursitis – for example, iliopsoas, ischial,
obturator and greater trochanter
KNEE
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Fractures
o femoral
o tibial
o patella
o head of fibula
Degenerative joint disease
Meniscal tears
Meniscal cysts
Ligament strains/tears
Chondral fractures
Acute stress fractures
Osteochondral lesions
Knee/patella dislocation
Osteochondritis dissecans
Bipartite patella with cyst
Bipartite patella without cyst
Patellofemoral chrondrosis
Subchondral cyst
Patellar cysts
CRPS I/II
Loose bodies
Excessive lateral compression syndrome
(ELPS) patella
Chronic subluxation patella
Recurrent traumatic dislocation of patella
Congenital dislocating patella
52
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Idiopathic patellafemoral chondromalacia
Osteonecrosis
Referred pain from hip and/or lumbar spine
Fat pad impingement
Arthrofibrosis
Quadriceps tendon tears/rupture
Patellar tendon tears/rupture
Patellar tendinopathy
Synovial hypertrophy
PVNS
Synovial haemangioma
Hoffa’s disease
Neuroma
Retinacular pain/tear
Thigh contusion/myositis ossificans
Pes anserinus bursitis
Prepatella bursitis
Chondrocalcinosis
FOOT AND ANKLE
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Fracture and dislocation
o tibia
o fibula
o talus
o navicular
o calcaneum
o cuboid
o cuneiforms
o metatarsal
o phalanges
Ligament injuries
Degenerative joint disease
Chondral lesions
Lisfranc disruption
Sinus tarsi syndrome
Hallux valgus and hallux rigidus
Plantar fasciitis
53
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Tendinopathy
Achilles tendon rupture
Tibialis posterior disruption
Tibio-talar impingement by meniscoid tissue
Peroneal tendon tears
Recurrent peroneal tendon subluxation or
dislocation
Syndesmosis disruption
Subtalar instability
Cuboid subluxation
Osteochondral lesion of the talus
Post-traumatic degenerative arthritis
CRPS I/II
Acute and chronic ankle instability – functional
and mechanical
Interdigital neuromas
Idiopathic metatarsophalangeal joint (MTPJ)
synovitis
Arthritis of the MTPJs
Cavus foot with plantar-flexed 1st and 2nd rays
Morton’s foot (long second metatarsal, short
first metatarsal)
Hyper mobile 1st ray
‘Turf toe’
Biomechanical-related disorders
SPINE

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
Fracture
o VB, end plate, TP, SP, pars
Ligamentous injury
Degenerative disease of disc, facet joint, modic
changes, canal stenosis
CERVICAL SPINE


Acute locking (wry neck)
Discogenic type
54
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Facet type
Cervical osteoarthrosis/RA of a facet joint
(usually upper cervical spine)
Cervical spondylosis degenerative intervertebral
disc (IVD) and vertebral bodies
‘Whiplash’ syndrome
Cervical myelopathy
THORACIC SPINE

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
Thoracic disc
Osteochondral rib
Thoracic myelopathy
LUMBAR SPINE
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Spinal stenosis
‘Facet’ joint syndrome
Disc pathology
Discitis
Nerve root syndrome
Spondylolisthesis
Spondylolysis
Scoliosis
Scheuermann’s disease
Osteoporosis
Ankylosing spondylitis
2. Differential diagnosis of non-musculoskeletal conditions
Rheumatology
The AMP has awareness of
the importance of:
The AMP is able to discuss
the signs and symptoms



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

The longevity of problem (acute vs chronic)
Recurring problems
Additional symptom development
Other areas becoming symptomatic
Osteoarthritis
55
associated with the
following:
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Ankylosing spondylitis
Diffuse idiopathic skeletal hyperostosis (DISH)
Reactive arthritis
Systemic lupus erythematosus (SLE)
RA
Psoriatic arthritis
Enteropathic arthropathies
Gout
Sicca syndrome
Polymyalgia rheumatica
Behcet’s syndrome
Fibromyalgia

Interrelation between ‘neuromuscular’ problems
such as carpal tunnel, adhesive capsulitis,
peripheral diabetic neuropathy, and endocrine
problems
The interrelation of other factors such as
alcoholism and obesity with endocrine problems
Endocrinology
The AMP demonstrates
awareness of the:

The AMP is able to discuss
the neuromuscular and
systemic signs and
symptoms associated with
endocrine dysfunction, for
example:







Chondrocalcinosis
Hypothyroidism
Diabetes mellitus
Metabolic alkalosis/acidosis
Osteoporosis
Osteomalacia
Paget’s disease
Oncology
56
The AMP demonstrates
awareness of the possible
red flags associated with
oncological conditions
The AMP is able to discuss
signs and symptoms
commonly associated with
cancer of the:


Musculoskeletal system
Neurological system
The AMP demonstrates knowledge of referred pain
patterns from oncological conditions
Visceral/vascular
The AMP demonstrates
knowledge of referred pain
patterns from visceral
organs, for example:







Heart (and vessels)
Lung
Kidney
Liver
Stomach
Intestines
Gall bladder
The AMP demonstrates
knowledge of vascular
conditions that may present
as musculoskeletal
conditions, for example:




DVT
Vascular claudication
Abdominal aortic aneurysm
Thoracic aortic aneurysm
Neurology
The AMP demonstrates
awareness of common
symptoms associated with
neurological conditions,
especially in relation to
motor and neuromuscular
57
problems
The AMP is able to discuss
signs and symptoms
commonly associated with
neurological problems, for
example:





Multiple sclerosis
Motor neurone disease
Parkinson’s disease
Cerebral vascular disease
Neurofibromatosis


Principles of ionising and non-ionising radiation
Risks and contraindications of each modality:
o plain film
o CT
o MRI
o ultrasound
o nuclear medicine
o interventional radiology
Pregnancy and protection of the fetus
3. Radiology
Radiation Safety
The AMP demonstrates
awareness of radiation
safety that includes:

Indications for imaging
The AMP can describe the
clinical decision-making
rules to determine the need
for imaging of the:







Shoulder
Elbow
Wrist and hand
Hip and pelvis
Knee
o Ottawa knee rules
o Pittsburgh decision rules
Foot and ankle
o Ottawa foot and ankle rules
Spine
o Canadian C-spine rules
o NEXUS
58
The AMP can describe the
indications, advantages and
disadvantages of the
imaging modalities – plain
film, CT, MRI, ultrasound,
nuclear medicine – in the
following regions:
The AMP describes the
imaging pathway for the
following suspected
conditions:
Requesting imaging
When requesting imaging
the AMP should be able to:























Shoulder
Elbow
Wrist and hand – scaphoid
Hip and pelvis
Knee
Foot and ankle
Cervical spine
Thoracolumbar spine
Fractures and dislocations
Cartilage and osteochondral lesions
Tendon and muscle ruptures
Ligamentous injuries
Degenerative joint conditions
Avascular necrosis
Stress fractures
Acute osteomyelitis
Bony metastases
Soft tissue mass
Multiple myeloma
DVT (outline Well’s criteria)
Recurrent shoulder dislocation
Recurrent patellofemoral joint dislocation
Recalcitrant tennis elbow




Describe the principles of requesting imaging
Define the ALARA principle
Discuss the responsibilities of the referrer
Understand informed consent and how this may
be documented
Describe the principles in assessing risk:benefit
ratios

59
Interpretation of imaging
When requesting imaging
the AMP should be able to
interpret plain films using a
systematic approach that
includes the following:





Routine check of name, date, side and site of
injury
Correct patient positioning, view and exposure
ABCS (alignment, bone, cartilage, soft tissue)
Common sites of injury or pathology
Common sites for missed injuries
SHOULDER, CLAVICLE, AC JOINT
The AMP has the ability to
recognise the
musculoskeletal conditions
from plain-film imaging, for
example:





Fractures
Dislocation
o anterior, posterior, luxato-erecta
Calcific tendinopathy
Osteoarthritis (OA)
Chronic degenerative supraspinatus tear
ELBOW, HAND AND WRIST








Fractures
o for example, Colles’, Barton’s, Smith’s,
Bennett’s, Rolando, Scaphoid, carpal,
boxers, etc.
o Monteggia and Galaezzi
o buckle and growth plate fractures
(Salter–Harris)
VISI and DISI deformities
Perilunate dislocation
Scapho-lunate dissociation
Volar plate
Keinböck’s disease
CPPD (calcium pyrophosphate dihydrate
deposition)
OA
HIP AND PELVIS

Fractures
o neck of femur, acetabular
60
o
o
o



avulsion
avascular necrosis (AVN)
stress fracture
OA
Hip dysplasias including Cam and Pincer
deformities
SUFE
KNEE





Fractures
o patella, tibial plateau, fibula
o avulsion – Segond
Effusion
Tendon ruptures – patella alta
OA
CPPD
FOOT AND ANKLE




Fractures
o Weber classification
o 5th, Jones
o Lisfranc’s
o calcaneum
OA
Gout – trophy
Tarsal coalitions, heel spurs
SPINE



Fractures
Degeneration
Spondylolisthesis
61
The AMP has the ability to
identify abnormal findings on
plain film of nonmusculoskeletal cause that
require a medical review and
may be diagnosed by the
medical team such as:





Acute osteomyelitis
Bony metastases
Multiple myeloma
Foreign bodies
Soft tissue mass
4. Principles of fracture management
Fracture management
The AMP demonstrates
awareness of the:
The AMP is aware of the
basic techniques of:
The AMP demonstrates
knowledge regarding factors
affecting:





Definitions of fractures
Describing of fractures
Fracture healing process
Classification of fractures
Principles of fracture management





Joint reductions
Plastering
Aftercare of patients in plaster
Removing plaster
Open fracture management


Fracture healing
Complications
o mal-union
o non-union
o joint stiffness
o AVN
o neurological
o fat embolism
o Sudeck’s atrophy
o visceral complications
o shortening/deformity
o epiphyseal arrest
o implant complications
62
Plastering (ED soft tissue review clinic only)
The AMP is able to describe  Indications for plastering
 Principles of plastering positioning for the
the following:
pathologies listed:
o wrist, hand and finger fractures
o scaphoid fractures
o ankle and foot fractures
o Achilles ruptures
 Precautions and warnings relating to plastering
 Aftercare management
The AMP can safely and
 Precautions taken when removing synthetic
effectively remove a plaster
casts
5. Pharmacology
The AMP demonstrates
knowledge of relevant
state/territory legislation
regarding use of medicines
The AMP demonstrates an
awareness of pharmacology
relevant to managing
musculoskeletal conditions
including:
The AMP demonstrates
knowledge about mode of
action, indications,
precautions and
contraindications, drug
interactions, adverse
reactions and side effects













Clinical pharmacology
Pharmacotherapeutics
Pharmacokinetics and pharmacodynamics
Special considerations for certain populations
(for example, paediatrics, older adults)
International, national and organisational
clinical guidelines in relation to medicine use
Analgesics
Antibiotics
Anti-inflammatories
Local anaesthetics
Nitrous oxide
Disease-modifying antirheumatic drugs
(DMARDs)
Neuropathic medications
Corticosteroids
63
and dosage of the following
drug classes:



Opioids
Diabetic medications
Androgen deprivation therapy (ADT)



The red blood cell
The white blood cell
Coagulation



Anaemia
Infection/neoplasia
Thrombosis/haemorrhage






Fluid and electrolyte balance
Sodium and potassium
The kidney
Liver function tests and plasma protein
Calcium
Thyroid function



Dehydration
Renal and liver failure
Diabetes


Urine analysis
Joint aspiration
6. Pathology
The AMP demonstrates a
basic understanding of three
main areas relating to
haematology and problems
associated with these areas:
The AMP can interpret
simple haematological
results and identifies when
medical involvement is
required
The AMP demonstrates a
basic understanding of the
key areas of biochemistry
and problems associated
with these areas:
The AMP can interpret
simple biochemistry results
and identifies when medical
involvement is required
The AMP demonstrates
knowledge of when the
64
following tests are indicated
and can interpret the results
in relation to differential
diagnosis of a
musculoskeletal condition
7. Diabetes
The AMP will have basic
knowledge that includes an
understanding of the
following:














Normal glucose and fat metabolism
Pathophysiology of diabetes
Definition of diabetes mellitus and common
comorbid conditions
How diabetes is diagnosed
Screening measures for diabetes
Differences between type 1, type 2 and
gestational diabetes
Impaired glucose tolerance and impaired
fasting glucose
Risk factors and preventative measures for type
2 diabetes
Self-managed of diabetes with the assistance
of a healthcare team
Role of the physiotherapist in supporting
individuals with diabetes
Need for good diabetes control – blood
glucose, lipids and blood pressure to limit
diabetes complications and maintain quality of
life
Role of medication in management of diabetes
Complications associated with diabetes
o cardiovascular risk
o macrovascular complications
o microvascular complications –
retinopathy, nephropathy and
neuropathy
Hypoglycaemia and hyperglycaemia
65
The AMP will have a
demonstrated ability to:













Take a history that includes all relevant
information required for assessment of a patient
with diabetes
Identify when blood glucose should be tested
Interpret results of blood glucose test and if
outside normal range make the appropriate
referral
Identify when use of urine glucose or ketone
monitoring is required
Interpret results and if outside normal range
make the appropriate referral
Recognise signs and symptoms of
hypoglycaemia and hyperglycaemia and know
how to act appropriately
Conduct a foot screening assessment
Assess for neuropathy and modify
management accordingly – for example,
application of plaster casts
Identify patients at risk of nephropathy and
implications of this on management
Identify patients at risk of retinopathy and
implications of this on management
Minimise tissue damage
Identify implications of fasting patients with
diabetes
Promote healthy lifestyle behaviours to patients
with diabetes
8. Communication
Verbal communication
The AMP demonstrates
advanced skills in
communicating at all levels
and in particular
demonstrates the ability to:



Use concise, systematic approach to verbally
presenting cases to expert colleagues
Acknowledge time restraints and competing
demands on expert colleagues and approaches
only when appropriate
Follows ISBAR approach when indicated and
appropriate
66
Documentation
The AMP will have a
demonstrated ability to:



Correctly document in the medical record by
following all:
o local policies and procedures
o national standards
o professional standards
Record accurate and complete clinical notes
that are either electronic or legibly hand written
Document clinical notes that are relevant,
objective, accurate and concise
Consent
The AMP will have a
demonstrated knowledge of:



The AMP will have a
demonstrated ability to:



Legislation regarding patient rights and consent
to treatment
Local organisational guidelines for consenting
patients
The barriers that limit a patient’s capacity to
consent
Clearly educate patients of the risks and
benefits of investigations or procedures prior to
gaining consent
Identify patients who are not able to consent
Troubleshoot when unable to obtain consent
67
Learning and assessment plan: screening clinics and ED soft tissue
review clinic (example only)
The Learning and assessment plan is separated into two sections: (1) the learning plan and (2) the
assessment plan. The learning plan outlines learning resources and describes various learning
activities to be undertaken as directed by the Learning needs analysis and as set by the organisation.
The assessment plan outlines the methods in which the competency assessment will occur, such as
work-based observed sessions, case-based presentations and oral appraisals. The assessment is
mapped back to the performance criteria of the competency standard and recorded on the Learning
and assessment plan. This is a flexible, adaptable document that may vary between organisations
and individuals. Each organisation should set and clearly document the minimum acceptable method
of assessment to determine competency as agreed with the relevant stakeholders (for example,
physiotherapy manager, orthopaedic director, radiology). The physiotherapist should keep all
documentation regarding the learning activities and assessment undertaken and develop a
professional practice portfolio that can then be used as evidence of prior learning should they transfer
their employment to another organisation in the future.
To develop the Learning and assessment plan the minimum acceptable method of assessment for
each performance criteria should be determined by first reviewing the Cumulative assessment tool.
This is a copy of the competency standard with recommended methods of assessment allocated to
each performance criteria. For some performance criteria there may be more than one method of
assessment recommended on the Cumulative assessment tool. There is an option to select and
record the preferred method of assessment indicated and many performance criteria may be
assessed more than once and additionally by more than one different method of assessment. The
Learning and assessment plan should document the method of assessment and the performance
criteria and address all performance criteria that are relevant to the role and are yet to be met. Refer
to the Learning and assessment plan for the AMP in the screening clinics or ED soft tissue review
clinic as an example of a completed Learning and assessment plan for a trainee engaging in the
whole learning and assessment program. The clinical lead physiotherapist is responsible for
developing the assessment component of the Learning and assessment plan in collaboration with the
physiotherapist undertaking the assessment and in accordance with the requirements of the
organisation.
An example Learning and assessment plan can be found on the following pages. A template Learning
and assessment plan can be found in the Appendix.
68
COMPETENCY STANDARD
ASSESSMENT TIMEFRAME
Deliver advanced musculoskeletal physiotherapy in orthopaedic and neurosurgery screening clinics
WORKPLACE LEARNING DELIVERY
OVERVIEW
A combination of the following will be implemented:
 self-directed learning
 coaching or mentoring
 workplace application
 formal external learning.
To be negotiated with clinical lead, assessor and/or line manager.
1. LEARNING ACTIVITIES/RESOURCES
TASK DESCRIPTION (add/delete according to individual and organisational needs)
Complete
d
X
1. Complete Learning needs analysis for the
work role
2. Complete site-specific orientation to
orthopaedic or neurosurgery screening
clinics
3. Complete learning modules as required
from the Learning needs analysis
# must be completed prior to requesting imaging
Not all learning modules have to be completed
prior to commencing competency assessment
Learning modules and other learning resources can be
accessed from the Victorian Department of Health
website: www.health.vic.gov.au/workforce/amp
Complete Competency standard self-assessment tool and Learning needs analysis (Part A
and B) and discuss learning needs, evidence of prior learning and assessment/verification
processes with clinical supervisor or line manager.
Complete orientation with clinical supervisor or line manager covering all details outlined in the
site-specific orientation guideline.
Learning modules to complete (add or delete learning modules relevant to area of practice):
 Musculoskeletal conditions/presentations specific to area of practice
 Radiology
o Radiation safety#
o Indications for imaging (learning objectives 2,3, 9–13)
o Requesting imaging
o Radiology interpretation (Screening, ED
 Pharmacology
 Pathology
 Differential diagnosis of non-musculoskeletal presentations
 Diabetes (APA diabetes e-module or equivalent in-house training)
 Communication (ISBAR)/consent/documentation
 Fracture management and plastering (ED soft tissue review clinic only – refer to ED
69
workbook)
4. Complete formal training if required – for
example, radiology, pharmacology and
diabetes
5. Complete further individual learning as
identified from the Learning needs analysis
6. Undertake supervised clinical practice and
feedback sessions
7. Review the following documents and become
familiar with the content in relation to advanced
(add or delete)
 The University of Melbourne – radiology single subject
Subject code: RADI90001 Radiology for Physiotherapists
 The University of Melbourne Pharmacology single subject
 APA e-modules diabetes for physiotherapists
http://www.learningseat.com/servlet/ShopLearning?categoryName=Browse+%BB+Physiot
herapy/Clinical+Content+%BB+Diabetes+For+Physiotherapists++8+CPD+Hours&learningId=38954
 Other
Complete further individualised learning as discussed with and directed by clinical supervisor
or line manager. This may include material beyond what is covered in the learning modules
above. In-service training provided by colleagues from departments such as pharmacy,
radiology, pathology can support the learning program.
(add or delete)
 Physiotherapists new to the work role who are undertaking the full learning and
assessment pathway will engage in a structured/timetabled work program as advised and
negotiated with their clinical supervisor/assessor.
 Physiotherapists new to the role should complete an orientation program that includes
shadowing and observation.
 Until an individual is deemed competent to practice independently within the setting they
require access to senior medical staff for clinical supervision.
 A graduated process from direct to indirect clinical supervision will be maintained during
this period until performance is at an independent standard and physiotherapists will be
supported by specific targeted feedback during this time, to address learning needs.
 A formative assessment should be conducted early into commencing the role and
throughout the supervision period to help the physiotherapist prepare for workplace
observation assessment(s) and oral appraisal. The formative assessment may be
conducted by the clinical lead physiotherapist; however, the workplace observation could
be conducted by a consultant familiar with the competency standard.
 Australian physiotherapy standards
http://www.physiocouncil.com.au/files/the-australian-standards-for-physiotherapy
70
musculoskeletal physiotherapy
8. Other activities to be advised (document
other activities organised to assist learning –
for example, Lightbox radiology course,
orthopaedic case conferences)

APA scope of practice
http://www.physiotherapy.asn.au/DocumentsFolder/Advocacy_Position_Scope_of_Practic
e_2009.pdf
 APRHA code of conduct/registration requirements
http://www.physiotherapyboard.gov.au/Codes-Guidelines.aspx
 Processes for issuing of sick leave certificates/WorkCover certificates or documentation
 Local organisational guidelines / clinical governance structure
 State/territory drugs and poisons Act: http://www.health.vic.gov.au/dpcs/reqhealth.htm
 Poisons Standard 2010: http://www.comlaw.gov.au/Details/F2010L02386
 Other
Add/delete
It is recommended the trainee conduct a self-assessment of their clinical record keeping at
intervals during the training program, in preparation for the record-keeping audit and using the
record-keeping audit assessment tool.
Other activities might include observing procedures such as shoulder hydrodilatation, spinal
injections or nerve blocks.
Add/delete
71
2. ASSESSMENT DETAILS AND LINKAGE (example)
ASSESSMENT TASK
1. Complete self-assessment tool – Learning needs analysis Part A and B (SA)
Due date
Performance
criteria
2.1, 3.1–2, 3.4–5
Self-assessment will include the physiotherapist completing the Learning needs analysis Part A and B:
I.
prior to commencing in the role
II.
prior to undergoing competency assessment.
The physiotherapist should discuss the completed self-assessment tool with their clinical lead, experienced physio or mentor,
and develop an individualised Learning and assessment plan.
2. Complete written responses (WR) Provide details of assessment task.
7.1, 7.5, 7.7, 15.5
Physiotherapists may be required to complete assigned written tasks – for example, multiple choice, short answer, online
quizzes
I.
WA imaging guidelines radiation safety online module (minimum of 80% correct)
This module should be completed during the orientation process before any imaging is requested
http://www.imagingpathways.health.wa.gov.au/includes/RadiationQuiz/quiz.html
II.
Interpretation of radiology case series (post arthroplasty)
3. Participate in direct workplace observation (WO)
For an agreed period of time the physiotherapist will work under supervision and, when deemed ready by self and supervisor,
the physiotherapist will undergo formal observation in the workplace. Refer to the Direct workplace observation assessment
checklist.
 The physiotherapist’s level of performance will be rated against the standard by the designated assessor using
assessment tool(s) during a formal assessment process.
 Occasions of direct workplace observation will be negotiated by the assessor with the physiotherapist.
 It is recommended that these observations of clinical practice are to include patient presentations with signs and
symptoms most common in presentation to area of practice. Alternatively the workplace observation may be the
assessment of specific clinical tasks such as special tests of the shoulder/knee (OSCE)
 Who the assessor is will vary depending upon the local organisation’s requirements. The assessor could be a
consultant who is familiar with the assessment process and competency standard requirements. They could also be
an experienced musculoskeletal physiotherapist.
Provide details of assessment task.
4. Maintain a professional practice portfolio (PF)
4.1–2, 5.1–5, 6.1–
7
7.1–7, 9.1–2, 9.5–
6, 9.9 10.1–2,
11.1–7, 12.1–2,
13.1–3, 15.1–6,
17.1–4, 18.1–3
1.2, 3.1–3
The professional practice portfolio required is consistent with the requirements of the APA’s requirements and should include
relevant information regarding attendance and participation in formal and informal education and learning opportunities specific
72
to advanced musculoskeletal physiotherapy area of practice.
This may include:
 self-reflective journal/diaries
 in-services, lectures, journal clubs, continuing education programs attended or given
 quality projects
 research activities and publications
 conference attendance
 mentoring/supervision sessions
 an electronic clinical log of types of conditions seen.
Please refer to:
 APA continuing development guidelines
www.physiotherapy.asn.au/APAWCM/Learning_and_Development/CPD_Overview/APAWCM/LearningDevelopment/
CPD_Overview.aspx
 APHRA guidelines for continuing education
www.physiotherapyboard.gov.au/documents/default.aspx
5. Provide documentary evidence (DE)
For example:
Participation in a record keeping audit – It is recommended that physiotherapists are required to provide documentary
evidence of predetermined number of health record entries, which will be audited using an audit assessment tool and
conducted by an assessor such as the clinical lead physiotherapist or a peer. Performance will be rated as satisfactory if at
least 80% of the applicable criteria are included in the samples. Feedback will be provided to the physiotherapist and
recommendations for improvement documented with a plan to ensure recommendations are implemented. Record-keeping
practice should be in line with the local organisation’s policies and the APA position statement on health records.
6. Give case-based presentations (CBP)
It is recommended that physiotherapists present a predetermined number of cases (five) to colleagues at a frequency
designated by the assessor/clinical lead/supervisor – Case-based presentation assessment tool
 It will be supported by verbal questioning by the assessor, centring on advanced clinical decision making.
 The level of performance will be rated against the standard by the designated assessor, using the appropriate casebased presentation assessment tool(s).
The presentations should address the required performance criteria as identified in this Learning and assessment plan.
Additional performance criteria may be added and addressed in case-based presentations.
7. Participate in performance appraisal (PA)
A performance appraisal should be conducted at the completion of an agreed timeframe by an allocated orthopaedic
consultant who has worked regularly with the physiotherapist. This appraisal is based on an informal observation of clinical
7.4, 9.8, 14.1
5.1–3, 5.5, 6.1–7,
7.2–3, 7.5, 7.7,
8.1–4,
9.1–2, 9.5–7, 9.9,
10.1–3, 11.1–7,
12.1–2, 15.1–5,
16.1–5, 17.1–4,
18.1–3, 19.1–4,
20.1–2
1.2, 2.1, 3.5, 4.1–
2, 5.4, 6.1–7, 7.6,
8.4, 8.5, 10.3,
73
practice over a period of time. This appraisal will include the following areas:
 working to full potential of the role
 accountability
 ability to work within limitations
 overall clinical practice
 communication with colleagues including
o presentation of cases
o recognition of when to involve colleagues
 management of workload
 use of resources.
Refer to the Performance appraisal assessment tool.
8. Undertake external qualification/training (Q/T)
11.3–7, 15.6
It is recommended the physiotherapist undertakes further external training. Examples of this include:
 The University of Melbourne single subject – ‘Radiology’
 The University of Melbourne single subject – ‘Pharmacology’
 APA diabetes learning modules 1–4 or equivalent in-house training.
To be guided by local organisation policies and guidelines.
7.7, 9.9, 16.1–5
9. Participate in oral appraisal (OA)
1.1, 9.3–4, 13.4
An oral appraisal can be conducted to assess aspects of workplace performance, as required and at the discretion of the
assessor (consultant or clinical lead physiotherapist) in relation to the relevant performance criteria. Refer to the OA
assessment tool.
For example the physiotherapist may be asked about:
 scope of practice
 knowledge about surgical procedures
 prioritisation of workload and use of resources
 clinical reasoning and decision-making processes regarding use of investigations and medications
 indications for making referrals to specialists.
It is recommended that this oral appraisal is conducted when the physiotherapist is ready to submit all forms of evidence for a
final assessment of competency to the designated assessor, who may be the clinical lead physiotherapist or nominated
consultant.
The physiotherapist is responsible for collating all assessment undertaken and recording this on the Cumulative assessment tool.
74
Workplace learning program
One aspect of the workplace learning program includes self-directed learning modules that use the
adult learning principles.1 These principles support the self-directed approach rather than the
traditional didactic teaching method. The learning modules can be accessed on the Victorian
Department of Health website. Ideally the modules should be accompanied by other learning activities
such as in-services provided by other specialty departments within the organisation such as
orthopaedics, pharmacy, pathology, radiology and the diabetes educators. All learning activities
undertaken should be documented in the professional practice portfolio. Other examples of learning
activities are included in the Learning and assessment plan and include attendance at orthopaedic
case conferences, external courses and lectures and conferences.
Learning modules
The learning modules for the ‘Advanced musculoskeletal physiotherapy services – screening clinics
and ED soft tissue review clinic’ are divided into key areas relevant to practice. All of these modules
do not need to be completed prior to starting in these roles; however, the section on radiation safety in
the radiology module should be completed during the initial orientation process and prior to
commencing the requesting of imaging.
How to use the learning modules
It is presumed a combination of team-based and individual learning approaches will be used. The
gaps identified in Learning needs analysis (Part A and B) should direct the focus for the learning
modules. The learning modules can be divided up among the team to complete and present back to
the musculoskeletal physiotherapy team at professional development sessions. Some elements of the
module may need to be completed individually as per the individualised Learning and assessment
plan agreed jointly with the clinical lead or mentor. There may be some learning objectives in the
modules that are not relevant to all organisations (for example, wound management) and/or some
learning objectives previously achieved and therefore do not need to be completed. Additionally there
is repetition and overlap in learning objectives across the modules. This is deliberate to allow the
learning modules to be a stand-alone document. It is not expected that every question in the
learning modules, particularly questions already addressed in other modules, need to be
answered – time should be spent on the areas identified as needing development and areas of
high priority and most likely presentations relevant to the practice context.
How much time should it take?
Non-clinical time must be allocated to complete the learning modules and this should be protected
time away from a clinical workload. The amount of time for learning should be negotiated as early as
possible and be dependent on the needs of the individual. The timeframe to complete the training
program will be dependent on the number of hours working in the role (full time or part time) and
should be determined in consultation with the clinical lead. The physiotherapist is responsible for
ensuring the modules are completed in a timely way in preparation for the work-based competency
assessment.
The learning modules assume a level of musculoskeletal skills and knowledge equivalent to that of
clinicians working at an APA titled master’s level. Hence, physiotherapists who have not completed
their master’s or gone through the APA experiential titling pathway may be required to undergo
additional competency assessment to address performance gaps that cannot be addressed within the
scope of this clinical education framework.
1
Knowles M S 1975, ‘Adult education: new dimensions’, Educational Leadership, 75, retrieved 26 November 2013,
<http://www.ascd.org/ASCD/pdf/journals/ed_lead/el_197511_knowles.pdf >.
75
It is important to note that not all parts of all the learning modules are required to successfully
complete the competency assessment. Some of the learning modules are for more experienced
advanced musculoskeletal physiotherapists (such as the differential diagnosis module) and can be left
to a later stage. The modules can be used as an ongoing tool to support learning in the future even
after competency has been achieved.
Example of learning modules for the ‘Advanced musculoskeletal physiotherapy service in the
orthopaedic and Neurosurgery screening clinics and ED review clinic’
Module
1
2
3
4
5
6
Domain
Musculoskeletal presentations
Shoulder
Elbow
Wrist and hand
Hip
Knee
Foot and ankle
Spinal
Radiology
Radiation safety#
Indications for imaging
Requesting imaging
Interpreting plain-film imaging (screening / ED review)
Osteoarthritis (optional)
*
Pharmacology
** The University of Melbourne pharmacology module
Pathology
7
Differential diagnosis of non-musculoskeletal presentations
8
*
9
Diabetes – APA diabetes module^ or in-house equivalent
10
Communication (ISBAR)/consent/documentation
* The University of Melbourne Radiology for Physiotherapists subject is conducted in the first
semester and complements the radiology self-directed learning module. Information about this subject
can be accessed at the University of Melbourne website:
https://handbook.unimelb.edu.au/view/2012/RADI90001
** The University of Melbourne Pharmacology subject is conducted in first semester by the School of
Pharmacy and complements the pharmacology self-direct learning module. Organisations may
stipulate this as a requirement for particular scope of practice such as physiotherapist-initiated
analgesia. While optional, for some specific practice context it may be recommended that trainees
engage in formal education in this area.
76
^ APA diabetes module is located at:
http://www.learningseat.com/servlet/ShopLearning?learningId=38954&categoryName=Diabetes+For+
Physiotherapists+-+8+CPD+Hours
* Modules 4 and 8 are Wound and Paediatrics respectively, which may not be required.
77
Competency-based assessment and related tools
Background
‘Competency based assessment is a purposeful process of systematically gathering, interpreting,
recording and communicating to stakeholders, information on candidate performance against industry
competency standards and/or learning programs’ (National Quality Council, 2009)
Assessment is an important part of any training system, not only for the learner but for the clinical
educator and for stakeholders.
For the learner, assessment provides feedback to guide their future learning and monitor their own
progress. For clinical educators, assessment allows them to verify that learning is taking place in line
with the required standard of performance and to determine their success in facilitating the learning
process. For stakeholders, assessment provides a way of knowing if people have the required
knowledge, skills and behaviours for the job. In this instance, the key stakeholders would include
employers and clinical supervisors from a variety of professions. As it stands now, competence
assessment of AMPs is not required to satisfy any professional association or legal requirements but
is broadly applied in some shape or form across the health sector.
Providing proof of competency achievement involves a process of gathering information (evidence),
matching it against the requirements of the competency standard and applying it in the workplace
using sound assessment principles. This process is assisted by using a variety of assessment tools
and instructions listed under the assessment resources section.
Assessing competence in the workplace using evidence
The type and amount of evidence required to support decisions of competence is not prescribed here;
however, recommendations regarding assessment methods mapped against the competency
standard are made to provide some guidance on how this might be done. These recommendations
are outlined in the Cumulative assessment tool and the Learning and assessment plan and are
supported by a number of other assessment checklists and tools, listed below. They provide a guide
only. Ultimately the amount and type of evidence to support decisions of competence for AMPs is at
the discretion of the organisation.
78
Principles of assessment
The principles of validity, reliability, flexibility, fairness and sufficiency should be applied to
assessment processes and decisions.
Principles of competency-based assessment as it applies to advanced musculoskeletal
physiotherapists
Principle
Key ideas

The assessor’s knowledge and skill is crucial to enhancing the validity of
the assessment process – this is enhanced by ensuring workplace
assessors meet specific criteria
 Evidence is gathered about performance by the assessor to justify
assessment judgements
 Assessment includes the range of knowledge and skills needed to
demonstrate competency with their practical application
 Where possible, includes judgements based on evidence from a number of
sources, occasions and across a number of contexts
Reliability (consistent
 Clear instruction for the assessor as to what must be identified and what
and accurate decisions)
constitutes the required performance level – this is enhanced by the
competency standard, performance cues and use of assessment tools and
instructions
 This is also enhanced by ensuring workplace assessors meet specific
criteria and that consistent conduct is used during assessments
 Consideration is given to the amount of error included in the evidence
Flexibility (when it can
 Assessment should reflect the candidate’s needs
accommodate the needs  It must provide for recognition of knowledge, skills and attitudes,
of learners, a variety of
regardless of how they have been acquired
delivery modes and
 Assessment must be accessible to learners through a variety of methods
delivery sites )
appropriate to context and the candidate
Fairness (when it places  Assessor considers the needs and characteristics of the candidate and
all learners on equal
includes reasonable adjustment where applicable
terms)
 Assessment is based on a participative and collaborative relationship
between the assessor and the candidate
 Assessment procedure is clear to all learners before assessment – this is
enhanced by learners having access to instructions and tools prior to
assessment
 Assessor is open and transparent about all assessment decision making
and maintains impartiality and confidentiality throughout the assessment
process
 Assessment decisions can be challenged and appropriate mechanisms are
made for reassessment as a result of the challenge
Sufficiency (relates to
 Refers to evidence as well as assessment methods
the quantity and quality
 Enough appropriate evidence needs to be collected and assessed to
of the evidence
ensure all aspects of the competency standard have been satisfied – this is
assessed)
enhanced by a well-developed assessment plan that includes evidence
recommended by subject matter experts
 Evidence should accurately reflect real workplace requirements and
include the range and complexity of patient presentations found in the
practice context
 Include a range of methods mapped to the competency standard
 Provide evidence from the assessment process that is acceptable to
stakeholders
Adapted from: National Quality Council 2009, Guide for developing assessment tools, DEEWR, Canberra,
pp. 24–28.
© Commonwealth of Australia
Validity (assessing what
it claims to assess)
79
Assessment resources
A number of assessment resources have been developed to support implementation in the
workplace. Some tools relate to establishing the suitability of the assessor and some can be used as
a recording tool during occasions of assessment; others help to ensure consistent processes are
used and that candidates are aware of how the assessment task will be conducted.
Not all assessment tools will be used in the competence assessment of individual candidates. The
tools used will depend on what assessment methods have been decided on by the organisation and
mapped in the Learning and assessment plan, the competences specific to the practice context and
the individual needs of the candidate. The assessment resources and a description of purpose and
use are included below.
Assessment resources
No. Name
Purpose
Assessment tools to assess candidates
1.1
Cumulative assessment To inform recommended
tool
assessment methods for
performance criteria
assessment and collate
all evidence to enable a
final decision on
workplace competence
How to use the resource
Use this tool as a starting and
endpoint.
At the beginning, the Cumulative
assessment tool provides a guide to
the assessment methods
recommended for specific
performance criteria, as relevant to the
work role. By using these
recommendations, the Learning and
assessment plan for the individual can
be refined.
At the endpoint this tool is used to
collate all the evidence collected from
assessment processes and indicate
the overall outcome of assessment
made by the assessor.
1.2
Competency standard
self-assessment tool:
Part A, Learning needs
analysis
To help clinicians reflect
meaningfully and to
identify strengths and
their own learning needs
as they relate to the
standards
Use this tool as a self-assessment
against the elements and performance
criteria at the beginning of the program
to assist in establishing the learning
needs of the individual to allow
tailoring of the Learning and
assessment plan.
1.3
Knowledge and skills
self-assessment tool:
Part B, Learning needs
analysis
To help clinicians reflect
meaningfully and to
identify strengths and
their own learning needs
as they relate to
underpinning knowledge
and skills
Use this tool as a self-assessment
against the underpinning knowledge
and skills at the beginning of the
program to assist in establishing the
learning needs of the individual to
allow tailoring of the Learning and
assessment plan.
1.4
Direct workplace
observation (WO)
(adult): assessment
checklist
To record performance
during a direct
observation assessment
against designated
performance criteria for
an adult patient
After adequate preparation of the
learner and due consideration of the
assessment context and conditions
(see additional resources below) the
tool is used to record performance
during a WO assessment. The number
of WO assessments is not fixed and
may vary depending on the range of
clinical presentations relevant to the
practice context, the level of
Includes a modified
checklist
Observed skills check
80
1.5
Direct workplace
observation (WO):
follow-up questions
To provide consistent
questions that can be
used to clarify
performance against
specific performance
criteria
1.6
Case-based
presentation (CBP):
assessment
instructions and
summary
1.7
Case-based
presentation (CBP):
assessment checklist
To help candidates and
assessors collate the
evidence collected by
case presentations and
inform learners on
assessment requirements
using this method
To record performance
during a case-based
presentation assessment
against designated
performance criteria
1.8
Record-keeping audit:
assessment tool
To record performance of
a candidate’s record
keeping against
designated criteria
1.9
Clinical audit: recording
tool
To record feedback by
peers given during a
clinical audit of random
health records
1.10
Performance appraisal
(PA): assessment tool
To capture the overall
performance of a
candidate over an agreed
timeframe as rated by a
performance of an individual in earlier
assessments or prior work experience
and training of an individual. See the
Learning and assessment plan for
details.
One tool should be used for each WO.
Ratings against all performance
criteria may not be possible on the one
assessment occasion, but for each
occasion an overall rating should be
given and effective performance
feedback given.
Assessors can select from this list of
questions to target performance
criteria that may not have been
observed in the WO, or to clarify the
candidate’s understanding in
performance criteria where
performance may fall short of the
expected standard.
Candidates use the tool to collate
evidence across a number of focus
areas and assessment occasions.
The assessment tool is used to record
performance during a CBP
assessment. As per the application in
the adult population, the number of
WO assessments is not fixed and may
vary. See the Learning and
assessment plan for details.
One tool should be used for each WO.
Ratings against all performance
criteria may not be possible on the one
assessment occasion, but for each
occasion an overall rating should be
given and recorded and constructive
feedback given.
This assessment tool is used by the
assessor to collate evidence over a
number of health record entries and
provide feedback to target areas for
improvement.
This recording tool is used by peers to
record feedback after reviewing the
content of medical record entries
against evidence-based practice and
best practice. Constructive feedback
will be provided to the physiotherapist
and recommendations for
improvement documented with a plan
to ensure recommendations are
implemented.
A performance appraisal should be
conducted at agreed times by a
consultant who has worked regularly
alongside the physiotherapist. This
81
consultant who has
worked regularly with the
candidate against
designated criteria
1.11
Oral appraisal (OA):
assessment tool
To record a candidate’s
performance against
designated criteria not
covered by other methods
of assessment
1.12
Radiological
To record performance
interpretation of a plain- during radiological
film case series:
interpretation of a plainassessment tool for the film case series against
candidate (available on
designated criteria
CD)
Additional resources for assessment preparation
2.1
Pre-assessment
To establish the suitability
checklist for workplace
of the workplace assessor
assessors: selfin accordance with
assessment tool
recommended minimum
criteria
2.2
Conditions and context
for assessment:
instructions
To inform candidates and
assessors of the contexts
and conditions required
for workplace assessment
2.3
Assessment
preparation checklist
To promote consistent
conduct and adequate
preparation of the
candidate prior to
assessment
2.4
Guidelines for
assessors conduct
during a direct
workplace observation
assessment
To promote consistent
conduct by assessors
during direct observation
assessment
appraisal is based on an informal
observation of clinical practice and
addresses designated criteria not
easily captured elsewhere. It may
provide supplementary evidence in
instances where engagement of
consultants in formal assessment
processes is difficult, such as a WO,
and is designed to promote
collaborative working relationships.
An oral appraisal takes place between
the candidate and the clinical lead or
consultant in a question and answer
format and addresses areas such as
legislation and scope of practice. The
assessor rates the answers on the
assessment tool.
The assessment tool is used to record
the candidate’s interpretation of plainfilm imaging case series as relevant to
the practice context. The assessor will
rate the performance of the candidate
as directed by the tool.
All workplace assessors should
complete the checklist to establish
their suitability as a workplace
assessor prior to assessing the
competency of candidates. This is to
be used as a guide only where there
are no legislated requirements or
additional organisational requirements
to be applied.
These instructions can be adapted as
needed but in their current format
provide general principles and
instructions to guide the assessment
process.
The candidate should have access to
these instructions and any
assessment tool(s) prior to the
assessment task. An opportunity for
clarification of these instructions prior
to assessment would also be given to
the candidate.
This checklist is to be used by the
assessor prior to the assessment of
the candidate to promote adequate
preparation for the ensuing
assessment and to ensure the
candidate has been fully informed. It is
particularly applicable for direct WO
assessments.
This provides a guide to how an
assessor should conduct themselves
during a direct observation
assessment. It is particularly
applicable for direct WO assessments
but the principles can and should be
applied to other forms of assessment.
82
Cumulative assessment tool – orthopaedic and neurosurgery physiotherapy screening clinics and ED soft tissue review clinic
Candidate’s name:
Assessment timeframe:
Name(s) of assessor(s) and designation:
Practice context area:
Did the candidate provide evidence of the following?
* The candidate must be rated as independent in all performance criteria to achieve competency.
PERFORMANC
E RATING
SCALE
RECOMMEND
ED
ASSESSMENT
(Ax)
METHOD(S)
INDICATE
METHODS
OF ASSESSMENT
USED




Self-assessment (SA)
Written responses (WR)
Oral appraisal (OA)
Documentary evidence
(DE)
 Workplace observation
(WO)
 Case-based
presentation (CBP)
 Qualification/training
record (Q/T)
 Portfolio (PF)
 Performance appraisal
(PA)
Independent (I)
Supervised (S)
Assisted (A)
Marginal (M)
Dependent (D)
PROFESSIONAL BEHAVIOURS
1. Operate within scope of practice
1.1 Identify and act within own knowledge base and scope of practice
1.2 Work towards the full extent of the role
2. Display accountability
2.1 Demonstrate responsibility for own actions, as it applies to the practice context
LIFELONG LEARNING
3. Demonstrate a commitment to lifelong learning
3.1 Engage in lifelong learning practices to maintain and extend professional competence
3.2 Identify own professional development needs, and implement strategies for achieving them
3.3 Engage in both self-directed and practice-based learning
3.4 Reflect on clinical practice to identify strengths and areas requiring further development
3.5 Formulate learning objectives and strategies for addressing own limitations
ROLE RELEVANCE (indicate)
work role
ELEMENTS AND PERFORMANCE CRITERIA
OA
PF, PA
SA, PA
PF, SA
PF, SA
PF
CBP, SA
83
COMMUNICATION
4. Communicate with colleagues
4.1 Use concise, systematic communication at the appropriate level when conversing with a range of
colleagues in the practice context
4.2 Present all relevant information to expert colleagues when acting to obtain their involvement
PROVISION AND COORDINATION OF CARE
5. Evaluate referrals
5.1 Discern patients who are appropriate for advanced physiotherapy management in accordance
with individual strengths or limitations, any legal or organisational restrictions on practice, the
environment, the patient profile/needs and within defined work roles
5.2 Discern patients who are appropriate for management in a shared care arrangement in
accordance with individual strengths or limitations, any legal or organisational restrictions on practice,
the environment, the patient profile/needs and within defined work roles
5.3 Defer patient referrals to relevant professionals (including other physiotherapists) when limitations
of skill or job role prevent the client’s needs from being adequately addressed, or when indicated by
local triage procedure
5.4 Prioritise referrals based on patient profile/need, organisational procedure or targets and any
local factors
5.5 Communicate action taken on referrals using established organisational processes
6. Perform health assessment/examination
6.1 Design and perform an individualised, culturally appropriate and effective patient interview with
common and/or complex conditions/presentations
6.2 Formulate a preliminary hypothesis and differential diagnoses for a patient with common and/or
complex conditions, as relevant to the practice context
6.3 Perform complex modifications to routine musculoskeletal assessment in recognition of factors
that may impact on the process such as the patient profile/needs and the practice context
6.4 Design and conduct an individualised, culturally appropriate and effective clinical assessment that
o is systems-based
o includes relevant clinical tests
o selects and measures relevant health indicators
o substantiates the provisional diagnosis
6.5 Identify when input is required from expert colleagues and act to obtain their involvement
6.6 Ensure all ‘red flags’ are identified in the assessment process, link ‘red flags’ to diagnoses not to
be missed and take appropriate action in a timely manner
WO, PA
CBP, WO
CBP, WO
WO, OA
CBP, WO
WO, CBP, PA
6.7 Ensure ‘yellow flags’ are identified in the assessment process and take appropriate action in a
timely manner
84
7. Apply the use of radiological investigations
7.1 Anticipate and minimise risks associated with radiological investigations
7.2 Determine the indication for imaging based on assessment findings and clinical decision-making
rules
7.3 Select the appropriate modality consistently and act to gain authorisation as required
7.4 Convey all required information on the imaging request consistently
7.5 Interpret plain-film imaging accurately using a systematic approach for patients with common
and/or complex conditions, as relevant to the practice context
7.6 Identify when input is required from expert colleagues and act to obtain their involvement
7.7 Meet threshold credentials and/or external learning and assessment processes set by the
organisation, governing body or state/territory legislation
WR, WO
CBP, WO
Other – as
determined by local
radiology department
DE, WO
CBP, WO, WR
WO, PA
Q/T, WR, WO,
CBP
Q/T = The University
of Melbourne
radiology subject
8. Apply the use of pathology tests in advanced musculoskeletal physiotherapy (under the direction and supervision of a consultant)
8.1 Determine the indication for pathology testing based on assessment findings and clinical decision
CBP
making rules
8.2 Identify the appropriate test(s) consistently and act to gain authorisation as required
8.3 Interpret pathology test results for patients with common and/or complex conditions, as relevant
to the practice context and in consultation with expert colleagues when required
8.4 Meet threshold credentials and/or external learning and assessment processes set by the
Not presently
organisation, governing body or state/territory legislation
available
9. Use therapeutic medicines in advanced practice (under the direction and supervision of a consultant)
9.1 Determine the indication and appropriate medication requirements from information obtained
WO, CBP
from the history taking and clinical examination and liaise with relevant health professionals regarding
this
9.2 Demonstrate knowledge of pharmacokinetics, indications, contraindications and precautions,
WR, CBP, WO
adverse effects, interactions, dosage and administration of medications commonly used to treat
musculoskeletal conditions, applicable to the practice context
9.3 Apply knowledge of the legal and professional responsibilities relevant to recommending,
OA
administering, using, supplying and/or prescribing medicines under the current legislation, as relevant
to the practice context
9.4 Comply with national and state/territory drugs and poisons legislation
OA
9.5 Identify when input is required from expert colleagues and act to obtain their involvement
WO, CBP, PA
9.6 Apply relevant knowledge of the medicine involved when recommending and informing patients
WO, CBP
of the risks and benefits of use
9.7 Exercise due care including properly assessing the implications for individual patients receiving
therapeutic medicine, as relevant to the practice context
9.8 Maintain proper clinical records as they relate to therapeutic medicine
DE
9.9 Meet threshold credentials and/or external learning and assessment processes set by the
Q/T, WO, CBP, Q/T = The University
85
organisation, governing body and national and state/territory legislation
10. Advanced clinical decision making
10.1 Synthesise and interpret findings from clinical assessment and diagnostic tests to confirm the
diagnosis
10.2 Demonstrate well-developed judgement in implementing and coordinating a patient
management plan that synthesises all relevant factors
10.3 Use finite healthcare resources wisely to achieve best outcomes
11. Formulate and implement a management/intervention plan
11.1 Formulate complex, evidence-based management plans/interventions as determined by patient
diagnosis, relevant to the practice context and in collaboration with the patient
11.2 Identify when guidance is required from expert colleagues and act to obtain their involvement
11.3 Facilitate all prerequisite investigations/procedures prior to consultation, referral or follow-up, as
relevant to the practice context
11.4 Assess the need for referral or follow-up and arrange if necessary
11.5 Identify when input to complement care is required from other health professionals and act to
obtain their involvement
11.6 Provide appropriate education and advice to patients with common and/or complex conditions,
as relevant to the practice context
11.7 Conduct a thorough handover to ensure patient care is maintained
12. Monitoring and escalation
12.1 Monitor the patient response and progress throughout the intervention using appropriate visual,
verbal and physiological observations
12.2 Identify and respond to atypical situations that arise when implementing the management
plan/intervention
13. Obtain patient consent
13.1 Explain own activity to the patient as it specifically relates to the practice context and check that
the patient agrees before proceeding
13.2 Consider the patient’s capacity for decision making and consent
13.3 Inform the patient of any additional risks specific to advanced practice proposed treatments and
ongoing service delivery and confirm their understanding
13.4 Employ strategies for overcoming barriers to informed consent as relevant to the practice
context
14. Document patient information
14.1 Document in the patient health record, fully capturing the entire intervention, consultation
process, addressing areas of risk and consent and including any referral or follow-up plans
WR
of Melbourne
pharmacology
subject
WO, CBP
PA, WO, CBP
WO, CBP
WO, CBP, PA
WO, CBP
WO
WO
OA
DE
86
ADDITIONAL ADVANCED PRACTICE CLINICAL SKILLS SPECIFIC TO PRACTICE CONTEXT
15. Implement management of fractures and simple joint reductions (physio ED review clinic)
15.1 Integrate knowledge of fracture management principles to assess and manage simple radial
head fractures or clinically suspected fractures where imaging is negative
15.2 Identify what fractures require the involvement of the orthopaedic team and provide appropriate
care until such review occurs
15.3 Identify the unstable knee and recognise when immediate orthopaedic attention is required
15.4 Recognise shoulder pathology of shoulder dislocation and associated injuries as well as AC
dislocation and liaises with orthopaedic team to ensure optimal management
15.5 Demonstrate the ability to safely and effectively apply musculoskeletal support where indicated
in managing musculoskeletal conditions
15.6 Apply and secure musculoskeletal support safely and effectively
16. Implement care of musculoskeletal conditions in patients with diabetes
16.1 Modify routine musculoskeletal assessment in recognition of a patient’s diabetic condition, as
relevant to the practice context
16.2 Modify routine musculoskeletal interventions in recognition of a patient’s diabetic condition, as
relevant to the practice context
16.3 Provide patients with diabetic conditions with information relevant to altering their health
behaviours and improving their health status
16.4 Identify when input is required from expert colleagues to assess and manage musculoskeletal
conditions in patients with diabetes and act to obtain their involvement
16.5 Apply evidence-based practice to managing musculoskeletal condition in patients with diabetes
17. Develop and implement a management plan for patients presenting with spinal pain
17.1 Perform appropriate spinal assessment with appropriate subjective examination, appropriate
objective examination and advanced clinical reasoning to offer appropriate advice to patients and
carers
WO, CBP, PA
WO
CBP, Q/T
Q/T = APA diabetes
module
WO, CBP
17.2 Demonstrate understanding of different surgical management for spinal pain, the typical
presentations, indications for surgery, risks and proposed benefits
17.3 Perform sufficient neurological examination that incorporates upper motor neurone and lower
motor neurone and peripheral nerve examinations with consistency in documentation standard
17.4 Identify which patients may respond to injections and have an understanding of the different
types of injections, their associated risks and efficacy and to be wary of advice of when patient is on
an anticoagulant medication
18. Develop and implement a management plan for patients presenting with limb pain
18.1 Performs appropriate peripheral assessment with appropriate subjective examination,
WO, CBP
87
appropriate objective examination and advanced clinical reasoning to offer appropriate advice to
patients and carers
18.2 Performs an adequate knee examination both subjective and objective in order to direct
conservative management and prioritise the knee pathologies that require more urgent surgical
intervention
18.3 Performs an adequate shoulder examination both subjective and objective in order to determine
which shoulder pathologies require conservative versus surgical management and in which
timeframes
19. Implement care of acute and persistent pain conditions
CBP
19.1 Identify the complexity, multidimensional and individual nature of the pain experience
19.2 Identify the impact of pain on society
19.3 Formulate a preliminary hypothesis, differential diagnoses and patient-centred management plan
19.4 Ensure management plans are designed to optimise patient compliance / treatment adherence
20. Implement appropriate care of acute and persistent pain conditions in patients who have psychological conditions including anxiety, depression and
post-traumatic stress disorder
CBP
20.1 Exercise due care in managing patients with acute and chronic pain with psychological
comorbidities including on referral of patients with poorly managed psychological symptoms or
considered at risk of self-harm
20.2 Demonstrate knowledge of the common psychological comorbidities associated with acute and
persistent pain
OVERALL COMPETENCY RESULT achieved in assessment timeframe
(*Independent rating required in all performance criteria to achieve competency)
Date:
Signature of candidate:
 Competent
Date:
Signature of assessor(s):
 Not yet competent
88
If competency NOT achieved, document performance criteria to be addressed and action plan
ORGANISATIONAL RECORDING PROCESSES COMPLETED
 Yes
 No
Author:
Version:
Last review date:
Next review date:
BONDY RATING SCALE
Scale label
Independent (I)
Standard of procedure
Safe
Accurate
Achieved intended outcome
Behaviour is appropriate to context
Supervised (S)
Safe
Accurate
Achieved intended outcome
Behaviour is appropriate to context
Assisted (A)
Safe
Accurate
Achieved most objectives for intended outcome
Behaviour generally appropriate to context
Marginal (M)
Safe only with guidance
Not completely accurate
Unsafe
Incomplete achievement of intended outcome
Dependent (D)
Unable to demonstrate behaviour
Lack of insight into behaviour appropriate to context
Quality of performance
Proficient
Confident
Expedient
Proficient
Confident
Reasonably expedient
Proficient throughout most of the performance
when assisted
Unskilled
Inefficient
Unskilled
Unable to demonstrate behaviour/procedure
Level of assistance required
No supporting cues required
Occasional supportive cues
Frequent verbal and occasional
physical directives in addition to
supportive cues
Continuous verbal and frequent
physical directive cues
Continuous verbal and physical
directive cues
X
Not observed
Reference: Bondy K N 1983, ‘Criterion-referenced definitions for rating scales and clinical evaluation’, Journal of Nursing Education, 22(9):376–381.
89
Direct workplace observation (WO) (screening clinics): assessment checklist
Candidate’s name:
Date:
Assessment linkage to competency standard: 4.1–2, 5.1–5, 6.1–7, 7.1–7, 9.1–2, 9.5–6, 9.9, 10.1–12, 11.1–7, 12.1–2, 13.1–3, 15.1–6, 17.1–4, 18.1–3
Workplace observation no. (circle):
1 2 3
additional as required
4
5 6
Assessor’s name and designation:

Other
Independen
t
Supervision
Assisted
Marginal
COMMUNICATION
4. Communicate with colleagues
Communication expert colleagues is concise, systematic and at appropriate level
or
N/A
Dependent
Link to
competency
standard
Candidate to indicate the type of patient presentation included in this workplace observation:
 Upper limb
 Lower limb
 Spinal
Performance rating scale 
Comments
ELEMENTS AND PERFORMANCE CRITERIA
X
Did the candidate provide evidence of the following?
4.1
All relevant information presented to expert colleagues
PROVISION AND COORDINATION OF CARE
5. Evaluate referrals
Appropriate patients included for advanced physiotherapy management
4.2
Shared care management applied appropriately
Patients deferred to other professionals appropriately
Referrals prioritised according to need
5.2
5.3
5.4
Action taken on referrals communicated
6. Perform health assessment/examination
Individualised, culturally appropriate and effective patient interview evident
Preliminary hypothesis formed
Differential diagnoses identified
Complex modifications to routine musculoskeletal assessment evident and
5.5
5.1
6.1
6.2
6.2
6.3
90
16.1
6.4
17.1
17.3
18.1
18.2
18.3
6.5
Input from expert colleagues obtained appropriately in assessment phase
18.2
18.3
6.6
‘Red flags’ are identified, with appropriate action taken
6.7
‘Yellow flags’ are identified, with appropriate action taken
7. Apply the use of radiological investigations in advanced musculoskeletal physiotherapy
Risks associated with radiological investigations minimised
7.1
Imaging selected is indicated and appropriate modality selected
7.2
7.3
Authorisation gained as required
7.3
appropriate
Individualised, appropriate and effective musculoskeletal assessment is evident
and is:
 systems-based and includes relevant clinical tests
 selects and measures relevant health indicators
 substantiates the provisional diagnosis
All required information conveyed on imaging request
7.4
Plain-film images are interpreted
7.5
 systematically
 accurately
Input on imaging is sought from expert colleagues appropriately
7.6
8. Apply the use of pathology tests in advanced musculoskeletal physiotherapy (under the direction and supervision of a consultant)
Risks associated with pathology tests are minimised
8.1
Indication for pathology tests are determined appropriately
8.2
Authorisation gained as required
8.3
When initiating pathology tests, all required information conveyed to appropriate
8.4
personnel
Pathology tests and results are interpreted
8.5
 appropriately
 in consultation with expert colleagues as appropriate
9. Apply the use of therapeutic medicines in advanced musculoskeletal physiotherapy (under the direction and supervision of a consultant)
9.1
Indicators and appropriate medication needs are identified and addressed
9.2
9.5
9.6
9.7
Appropriate input on medications is sought from expert colleagues
9.1
9.5
91
Knowledge of pharmacokinetics, indications, contraindications, precautions,
adverse effects, interactions, dosage, administration of medications commonly
used to treat musculoskeletal conditions is applied
10. Advanced clinical decision making
Findings interpreted and synthesised to confirm the diagnosis
Management plan shows well-developed judgement, with synthesis of all
relevant factors
11. Formulate and implement a management/intervention plan
Plan is evidence-based, appropriate and made in collaboration with patient
Input on plan is sought from expert colleagues appropriately
All prerequisite investigations or procedures are facilitated prior to
consultation or referral
Complex modifications to routine musculoskeletal intervention evident and
includes providing appropriate patient and carer education
9.2
9.6
10.1
10.2
11.1
11.2
15.2
15.3
15.4
11.3
11.6
15.1
15.2
15.3
15.4
17.2
17.4
18.1
18.2
18.3
11.4
11.6
11.7
Referral and follow-up arranged appropriately
Appropriate education and advice to patient provided
Thorough handover conducted
12. Monitor and escalate care
Patient response and progress monitored appropriately throughout the intervention 12.1
12.2
13. Obtain patient consent
Own activity as it specifically relates to the practice context explained and
13.1
checked that the patient agreed before proceeding
Patient’s capacity for decision making and consent considered
13.2
Patient informed of risks and their understanding confirmed
13.3
OPTIONAL FOLLOW-UP QUESTIONS FOR THE ASSESSOR TO CONSIDER
92
What are the risks associated with ordering plain x-rays?
What are the key principles to apply to minimise risk associated with plain x-rays?
What are the indications for imaging the following regions:
o peripheral joints (UL and LL) and spinal?
What are three examples of clinical decision-making rules for imaging?
What are the risks associated with pathology tests and what do clinicians requesting
pathology tests need to do to minimise these risks?
Provide an example of what and when pathology tests may be indicated.
What tests can be initiated by a physiotherapist?
What is the process when pathology tests are indicated but can’t be initiated by a
physiotherapist?
In what situations should expert colleagues be consulted in relation to medicines and
what important information needs to be conveyed?
7.1
When is over-the-counter analgesia indicated and what is the relevant information to
inform patients of when recommending over-the-counter analgesia?
When is over-the-counter analgesia not indicated?
Explain your clinical decision making.
9.6
9.7
9.7
Provide an example of a situation where you have faced an atypical situation and
discuss how you managed the situation.
What are the principles of fracture management and joint reductions that indicate
when input from expert colleagues are required?
Provide an example of when input is required from expert colleagues in the care of a
patient with spinal pain.
Provide an example of when input is required from expert colleagues in the care of a
patient with limb pain.
OVERALL COMPETENCY / RESULT PERFORMANCE LEVEL
Dependent Marginal Assisted Supervised Independent
7.2
8.1
8.2
8.3
9.5
12.
2
10.
1
10.
2
12.
2
15.
5
Date:
Signature of assessor(s):
Signature of candidate:
93
SPECIAL QUESTIONS / COMMENTS / FURTHER ACTION
ORGANISATIONAL RECORDING PROCESSES COMPLETED
 Yes
 No
Author:
Version:
Last review date:
Next review date:
BONDY RATING SCALE
Scale label
Independent (I)
Standard of procedure
Safe
Achieved intended outcome
Accurate
Behaviour is appropriate to context
Supervised (S)
Safe
Accurate
Achieved intended outcome
Behaviour is appropriate to context
Assisted (A)
Safe
Accurate
Marginal (M)
Safe only with
guidance
Not completely
accurate
Unsafe
Achieved most objectives for intended
outcome
Behaviour generally appropriate to
context
Incomplete achievement of intended
outcome
Dependent (D)
Unable to demonstrate behaviour
Lack of insight into behaviour appropriate
to context
Quality of performance
Proficient
Confident
Expedient
Proficient
Confident
Reasonably expedient
Proficient throughout most of the
performance when assisted
Level of assistance required
Unskilled
Inefficient
Continuous verbal and frequent
physical directive cues
Unskilled
Unable to demonstrate
behaviour/procedure
Continuous verbal and physical
directive cues
No supporting cues required
Occasional supportive cues
Frequent verbal and occasional
physical directives in addition to
supportive cues
X
Not observed
Reference: Bondy K N 1983, ‘Criterion-referenced definitions for rating scales and clinical evaluation’, Journal of Nursing Education, 22(9):376–381.
94
Direct workplace observation (WO) (screening clinics): modified assessment
checklist
Candidate’s name:
Date:
Assessment linkage to competency standard: 4.1–2, 5.1–5, 6.1–7, 7.1–7, 9.1–2, 9.5–6, 9.9, 10.1–
2, 11.1–7, 12.1–2, 13.1–3, 15.1–6, 17.1–4, 18.1–3
 Within each workplace observation not all performance criteria may be appropriate to
be assessed.
 Performance criteria may be carried over for assessment in the next workplace
observation.
 Once all performance criteria have been assessed as independent no further
workplace observations will be required.
Workplace observation no. (circle):
1 2 3
additional as required
4
5
Assessor’s name and designation:
Candidate to indicate the type of patient presentation included in this workplace observation:

Upper limb

Lower limb

Spinal

Other
BONDY RATING SCALE
Scale label
Standard of procedure
Quality of performance
Level of assistance
required
Independent
(I)
Safe
Accurate
Achieved intended outcome
Behaviour is appropriate to
context
Proficient
Confident
Expedient
No supporting cues required
Supervised
(S)
Safe
Accurate
Achieved intended outcome
Behaviour is appropriate to
context
Proficient
Confident
Reasonably expedient
Occasional supportive cues
Assisted (A)
Safe
Accurate
Achieved most objectives
for intended outcome
Behaviour generally
appropriate to context
Proficient throughout
most of the performance
when assisted
Frequent verbal and occasional
physical directives in addition to
supportive cues
Marginal (M)
Safe only with
guidance
Not completely
accurate
Unsafe
Incomplete achievement of
intended outcome
Unskilled
Inefficient
Continuous verbal and frequent
physical directive cues
Unable to demonstrate
behaviour
Lack of insight into
behaviour appropriate to
context
Unskilled
Unable to demonstrate
behaviour/procedure
Continuous verbal and physical
directive cues
Dependent
(D)
X
Not observed
Reference: Bondy K N 1983, ‘Criterion-referenced definitions for rating scales and clinical evaluation’, Journal of Nursing
Education, 22(9):376–381.
95
Comments
Independe
nt
Supervisio
n
Assisted
or
N/A
Marginal
Patients deferred to other professionals appropriately
Referrals prioritised according to need
Performance rating
scale
X
Dependent
Communication
Communication expert colleagues is concise, systematic and at
appropriate level
All relevant information presented to expert colleagues
Provision and coordination of care
Appropriate patients included for advanced physiotherapy
management
Shared care management applied appropriately
Link to comp.
standard
ELEMENTS AND PERFORMANCE CRITERIA
Did the candidate provide evidence of the following?
4.1
4.2
5.1
5.2
5.3
5.4
5.5
Action taken on referrals communicated
Perform health assessment/examination
Individualised, culturally appropriate and effective patient interview 6.1
evident
6.2
Preliminary hypothesis formed
6.2
Differential diagnoses identified
6.3,
An individualised, appropriate and effective musculoskeletal
16.1
assessment conducted
‘Red flags’ and ‘yellow flags’ are identified, with appropriate action 6.6–7
taken
Apply the use of radiological investigations in advanced musculoskeletal physiotherapy
Imaging selected is indicated, risks are minimised and appropriate 7.1–3
modality selected
7.4
All required information conveyed on imaging request
7.5
Plain-film images are interpreted systematically and accurately
Apply the use of pathology tests in advanced musculoskeletal physiotherapy (under the direction and supervision of a
consultant)
8.1
Risks associated with pathology tests are minimised
8.2
Indication for pathology tests are determined appropriately
8.3
Authorisation gained as required
8.4
All required information conveyed to appropriate personnel when
initiating pathology tests
8.5
Pathology tests and results are interpreted appropriately and in
consultation with expert colleagues as appropriate
Apply the use of therapeutic medicines (under the direction and supervision of a consultant)
9.1–2
Acted to ensure use of medicines is indicated, safe and effective
9.6
Advanced clinical decision making
Findings interpreted and synthesised to confirm the diagnosis
Management plan shows well-developed judgement, with
synthesis of all relevant factors
Formulate and implement a management/intervention plan
Plan is evidence-based, appropriate and made in collaboration
with patient
Input on plan is sought from expert colleagues appropriately
All prerequisite investigations or procedures are facilitated prior to
consultation or referral
Complex modifications to routine musculoskeletal intervention are
evident and include providing appropriate patient and carer
education
10.1
10.2
11.1
11.2
15.2–4
11.3
11.6
15.1–4
17.2
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Referral and follow-up arranged appropriately
Provided appropriate education and advice to patient
Thorough handover conducted
Monitor and escalate care
The patient response and progress monitored throughout the
intervention appropriately
Obtain patient consent
Own activity as it specifically relates to the practice context
explained and checked that the patient agreed before proceeding
The patient’s capacity for decision making and consent considered
Patient informed of risks and confirmed understanding
17.4
18.1–4
11.4
11.6
11.7
12.1–2
13.1
13.2
13.3
OPTIONAL FOLLOW-UP QUESTIONS FOR THE ASSESSOR TO CONSIDER
What are the risks associated with ordering plain x-rays?
What are the key principles to apply to minimise risk associated
with plain x-rays?
What are the indications for imaging the following regions:
o peripheral joints (UL and LL) and spinal?
What are three examples of clinical decision making rules for
imaging?
What are the risks associated with pathology tests and what do
clinicians requesting pathology tests need to do to minimise these
risks?
Provide an example of what and when pathology tests may be
indicated.
What tests can be initiated by a physiotherapist?
What is the process when pathology tests are indicated but can’t
be initiated by a physiotherapist?
In what situations should expert colleagues be consulted in relation
to medicines and what important information needs to be
conveyed?
When is over-the-counter analgesia indicated and what is the
relevant information to inform patients of when recommending
over-the-counter analgesia?
When is over-the-counter analgesia not indicated?
Explain your clinical decision making.
Provide an example of a situation where you have faced an
atypical situation and discuss how you managed the situation.
SPECIAL QUESTIONS / COMMENTS / FURTHER ACTION
OVERALL COMPETENCY/RESULT PERFORMANCE LEVEL
Dependent Marginal Assisted Supervised Independent
ORGANISATIONAL RECORDING PROCESSES COMPLETED
7.1
7.2
8.1
8.2
8.3
9.5
12.2
9.6-7
9.7
10.1-2
12.2
Date:
Signature of assessor(s):
Signature of candidate:
 Yes
 No
97
Direct workplace observation (WO) (screening clinics): skills assessment checklist
Candidate’s name:
Date:
Assessment linkage to competency standard: 6.3-4, 15.1–5 (ED review), 17.1, 17.3 (spinal), 18.1–3 (limb)
 Within each workplace observation not all performance criteria may be appropriate to be assessed.
 Three clinical tests per peripheral region may be chosen to be demonstrated.
 Once all performance criteria has been assessed as independent no further workplace observations will be required.
Assessor’s name and designation:
BONDY RATING SCALE
Scale label
Independent (I)
Standard of procedure
Safe
Accurate
Achieved intended outcome
Behaviour is appropriate to context
Supervised (S)
Safe
Accurate
Achieved intended outcome
Behaviour is appropriate to context
Assisted (A)
Safe
Accurate
Safe only with guidance
Not completely accurate
Unsafe
Achieved most objectives for intended outcome
Behaviour generally appropriate to context
Incomplete achievement of intended outcome
Marginal (M)
Dependent (D)
Unable to demonstrate behaviour
Lack of insight into behaviour appropriate to context
Quality of performance
Proficient
Confident
Expedient
Proficient
Confident
Reasonably expedient
Proficient throughout most of the
performance when assisted
Unskilled
Inefficient
Unskilled
Unable to demonstrate
behaviour/procedure
Level of assistance required
No supporting cues required
Occasional supportive cues
Frequent verbal and occasional physical
directives in addition to supportive cues
Continuous verbal and frequent physical
directive cues
Continuous verbal and physical directive
cues
X
Not observed
Reference: Bondy K N 1983, ‘Criterion-referenced definitions for rating scales and clinical evaluation’, Journal of Nursing Education, 22(9):376–381.
98

Shoulder labral integrity tests
Lower limb
Choose three of the following to demonstrate appropriate tests.
 Anterior cruciate ligament integrity tests

MCL/LCL integrity tests

Meniscal integrity tests

Posterolateral corner integrity tests

Patellofemoral stability tests
Spinal
Demonstrate a full UL and LL neurological examination inclusive of UMN and LMN assessment.
 Dermatomes

Myotomes

Reflexes

UMN tests
OPTIONAL FOLLOW-UP QUESTIONS FOR THE ASSESSOR TO CONSIDER
What are the indications for imaging the following regions?

Peripheral joints (UL and LL)

Independent
Shoulder apprehension tests
Supervisio
n

or
N/A
Assisted
Rotator-cuff pathology tests
X
Marginal

Performance rating scale 
Dependent
Upper limb
Choose three of the following to demonstrate appropriate tests.
 Shoulder impingement tests
Link to
competency
standard
ELEMENTS AND PERFORMANCE CRITERIA
Did the candidate provide evidence of the following?
18.1
18.3
18.1
18.2
17.1
17.3
7.2
Spinal
What are some examples of clinical decision making rules for imaging?
What type of presentations would require input from an orthopaedic or neurosurgical consultant on the
day of assessment?
6.5
7.6
99

Upper limb

Lower limb

Spinal
OVERALL COMPETENCY/RESULT PERFORMANCE LEVEL
Dependent Marginal Assisted Supervised Independent
11.2
15.2–4
16.4
Date:
Signature of assessor(s):
Signature of candidate:
SPECIAL QUESTIONS / COMMENTS / FURTHER ACTION
ASSESSMENT ADDED TO ASSESSMENT RECORD
 Yes
 No
 N/A
100
Case-based presentation (CBP): assessment checklist
Candidate’s name:
Date:
Assessment linkage to competency standard: 3.4, 5.1, 5.2, 5.5, 6.1–7, 7.2, 7.3, 7.5, 7.7, 8.1–4, 9.1, 9.2, 9.5–7, 9.9, 10.1–3, 11.1–7, 12.1, 12.2, 15.1–5,
16.1–5, 17.1–4, 18.1–3, 19.1–4, 20.1, 20.2
(circle if complete)
Case presentation no. (circle):
1 2 3 4 5
Assessor’s name and designation:
Audience:
Candidate to indicate the patient profile/condition(s) or assessment focus included in this presentation:
History and examination findings of patients with conditions
of:
 Upper limb
 Lower limb
 Spinal
Patient profile/condition
 Diabetes (criteria 16.1–5)
 Spinal pain (criteria (17.1–4)
 Limb pain (criteria 18.1–3)
 Pain conditions (criteria 19.1–4)
Management/intervention required
 Imaging
 Pathology
 Pharmacological requirements
Patient care required
 Shared model of care / transfer of care (circle)
 Escalation in response to an atypical situation
 Reflection on clinical practice
 Evidence of advanced clinical decision making and formulation of complex
management plans
Did the candidate provide evidence of the following?
Link to
comp.
standard
Satisfactory = S
Not applicable = N/A
Not satisfactory = NS
Not observed = X
S
NS
N/
A
or
X
Comments: Areas performed well, areas for
improvement, criteria still requiring evidence – for
example, N/A or NS
Referrals
Shared care arrangement applied appropriately
5.2
Patients deferred to other professionals appropriately
5.3/5.5
Health assessment/examination
Appropriate and effective patient interview evident
6.1
Preliminary hypothesis formed and differential diagnosis
6.2
identified
101
Complex modifications to routine musculoskeletal assessment
evident
(for example: 16 diabetes)
Appropriate, effective, individualised musculoskeletal
assessment is evident and is:
o systems-based
o includes relevant clinical tests
o selects and measures relevant health indicators
o substantiates the provisional diagnosis
Input from expert colleagues obtained appropriately in
6.3, 16.1
6.4, 17.1,
17.3,
18.1,
18.2,
18.3
‘Red flags’ are identified, with appropriate action taken
6.5, 17.4,
18.2,
18.3
6.6
‘Yellow flags’ are identified, with appropriate action taken
6.7
assessment phase
Radiological investigations
Imaging selected is indicated and appropriate
Input on imaging is sought from colleagues appropriately
Radiological images accurately and systematically interpreted
Pathology tests
Pathology tests and results are interpreted appropriately
7.2, 7.3,
16.2
7.3
7.5
8.1, 8.2,
8.3
8.3
Input on pathology tests sought from colleagues appropriately
Therapeutic medicines
Indicators and appropriate medication needs of the patient are 9.1, 9.2,
identified and addressed
9.5, 9.6,
9.7
Appropriate input on medications is sought from colleagues
9.1, 9.5
Knowledge of pharmacokinetics, indications, contraindications 9.2
and precautions, adverse effects, interactions, dosage and
administration of medications commonly used to treat
musculoskeletal conditions is applied
Advanced clinical decision making
Findings interpreted and synthesised to confirm the diagnosis 10.1
Management plan shows well-developed judgement, with
10.2
synthesis of all relevant factors
102
Management/intervention plan
Plan is evidence-based and appropriate to diagnosis
11.1
Plan is made in collaboration with patient/family
11.1,
20.3
Input on plan is sought from colleagues appropriately and
handover is adequate when indicated
11.2,
15.2–4,
16.4,
Complex modifications to routine musculoskeletal intervention, 11.6,
evident (for example: 15 fractures, 16 diabetes, 17 spinal, 18
15.1-4,
limb pain, 19 pain, 20 persistent pain) and includes providing
16.2,
appropriate patient and carer education
17.2,
17.4,
19.4,
20.1
Referral and follow-up appointments/investigations arranged
10.3,
appropriately and resources used wisely
11.3,
11.4,
11.5
Monitoring and escalation
Monitor and escalate when atypical situations arise and
implement the management plan/intervention appropriately
12.1,
12.2
Lifelong learning
Reflection on clinical practice to identify strengths and areas
requiring further development is evident
OVERALL PERFORMANCE (circle to indicate)
Satisfactory Not satisfactory
3.4
Signature of assessor(s):
Signature of candidate:
SPECIAL QUESTIONS / COMMENTS / FURTHER ACTION
ASSESSMENT TASK ADDED TO ASSESSMENT RECORD
 Yes
 No
 N/A
103
Case-based presentation (CBP): assessment instructions and summary
Candidate’s name:
Assessment linkage to competency standard: 3.4, 5.1, 5.2, 5.5, 6.1–7, 7.2, 7.3, 7.5, 7.7, 8.1–4, 9.1, 9.2, 9.5–7, 9.9, 10.1–3, 11.1–7, 12.1, 12.2, 15.1–5, 16.1–5,
17.1–4, 18.–3, 19.1–4, 20.1, 20.2
Assessment instructions:
1. Candidates must satisfactorily complete a minimum of five case-based presentations that, when tracked in the table below, cover the full range of
assessment focus areas.
2. The frequency and timing of the CBP will be designated by the assessor, clinical lead or supervisor.
3. Please confirm any additional requirements with the assessor – for example, access to patient’s medical number, access to patient’s imaging, de-identified
notes.
4. Each presentation should attempt to address as many of the performance criteria listed on the CBP assessment tool as possible.
5. Using the table below, the candidate needs to track performance criteria yet to be observed or satisfactorily completed.
6. At the completion of the five CBPs, all performance criteria need to have been observed and satisfactorily completed; these can be tracked in the table
below.
7. CBPs will be supported through oral appraisal by the assessor, centring on advanced clinical decision making.
CBP no.
CBP 1
CBP 2
CBP 3
CBP 4
CBP 5
Date of completion
Result S / NS
List performance criteria, yet to be observed or satisfactorily
completed
Assessor’s name and designation
104
Track the content of the CBP by ticking the assessment focus areas below
CBP 1 
Assessment focus area
History and examination findings, of patients with conditions of:
 Upper limb
 Lower limb
 Spinal
Patient profile/condition
 Diabetes
Management/intervention required
 Imaging
 Pathology
 Pharmacological requirements
Patient care required
 Shared model of care / transfer of care
 Escalation in response to an atypical situation
Reflection on clinical practice
Evidence of advanced clinical decision making and formulation of
complex management plans
OVERALL PERFORMANCE for all assessed case-based
presentations
(circle to indicate)
Satisfactory
Not satisfactory
ORGANISATIONAL RECORDING PROCESSES COMPLETED
Author:
Version:
 Yes
CBP 2 
CBP 3 
CBP 4 
CBP 5 
Signature of assessor(s) and designation:
Date:
Signature of candidate:
Date:
 No
Last review
date:
Next review
date:
105
Advanced musculoskeletal physiotherapy - clinical and recordkeeping audit guideline
TARGET AUDIENCE
Musculoskeletal physiotherapists
Physiotherapy manager
Medical directors of relevant unit (emergency, orthopaedics and neurosurgery)
PURPOSE
The purpose of this guideline is to provide a tool to audit performance of advanced musculoskeletal
physiotherapists to ensure patient safety and quality of care is maintained at the highest level.
GUIDELINE
Audits have been identified as a clinical governance activity in the Advanced musculoskeletal
physiotherapy clinical governance guideline to assist in the process of demonstrating clinical
effectiveness of advanced musculoskeletal physiotherapists. Two different audit activities that will be
undertaken will be described in this guideline.
Definitions
Record-keeping audit
A record-keeping audit is a process that establishes whether physiotherapy documentation, within the
medical record, referral or handover, meets accepted legal, professional and statutory requirements.
For both audit activities medical records will be used; however, for the clinical audit the relevance of
the clinical content documented in the medical record will be discussed against clinical standards and
evidence-based practice (wether what was done or not done was appropriate for the context). The
record-keeping audit will assess the way it was recorded in terms of health record-keeping standards.
Clinical audit
Clinical audit is a systematic, critical analysis of the quality of clinical care that is reviewed by peers
against an explicit criteria or recognised standards, and then used to further inform and improve
clinical practice. Its ultimate goal is improving quality of care for patients. Its purpose is to examine
whether what you think is happening really is, and whether current performance meets existing
standards. The environment in which audit and peer review takes place should be one of open
discussion based on accurate data and an understanding of the role of systems issues.
AUDIT METHODS
Record-keeping audit
This involves a random sample of 10 records (medical records of patients will be selected by the
clinical lead physiotherapist for each advanced musculoskeletal physiotherapist). The medical UR
number will be selected from the electronic clinical log (Access database). The patient’s medical
history and their corresponding UR number will be accessed on PowerChart by the clinical lead. The
106
record-keeping audit assessment form can be completed by the clinical lead or an allocated peer
(Tool 1) for three patients. The results of this assessment will be discussed with the advanced
musculoskeletal physiotherapist and recommendations of areas for improvement will be made with a
plan to address the recommendations. If the results of the record-keeping audit are not satisfactory
further medical records may be accessed and/or the record-keeping audit repeated again after a
period of time once the recommendations to the physiotherapist have be implemented.
Self-assessment
A self-assessment of record keeping should be conducted by the advanced musculoskeletal
physiotherapist using the assessment form throughout the training period and on a regular basis
using the record-keeping assessment tool.
Clinical audit (peer reviewed)
From the sample of 10 records used in the record-keeping audit or from any other cases identified,
the clinical lead physiotherapist will select up to three medical records to be used for the clinical audit
(they may be the same records used for the record-keeping audit or be a different three patients – this
will be up to the discretion of the clinical lead). The clinical lead will review the content of the medical
records and be rated according to evidence-based practice and best practice standards. The clinical
audit assessment form will be completed (Tool 2). A medical consultant may also be involved in this
process as determined by the relevant individual medical units. A peer review process with feedback
to the advanced musculoskeletal physiotherapist will be scheduled with the clinical lead (with or
without a medical consultant). The peer review process should be documented with recommendations
of actions to address areas requiring improvement and the plan to evaluate and monitor the
implemented actions. The advanced musculoskeletal physiotherapist should keep a copy of the
documentation for their professional practice portfolio, which will contribute to their work-based
competency assessment and the ongoing assessment of competency.
The clinical lead may decide to present the case to the team of advanced musculoskeletal
physiotherapist to share the opportunity for learning at a scheduled continuing education session.
This must be done with the permission of the advanced musculoskeletal physiotherapist and with
identity of the people involved removed to protect patient and staff privacy. Further audits may be
required at the discretion of the clinical lead.
Reporting
The clinical lead physiotherapist for the advanced musculoskeletal physiotherapy service will be
responsible for reporting the results of the clinical audit and record-keeping audit to the physiotherapy
manager and medical director annually.
Advanced musculoskeletal physiotherapy trainees will be expected to complete the clinical audit and
record-keeping audit requirements prior to undertaking their work-based competency assessment.
Once deemed competent all advanced musculoskeletal physiotherapist will be expected to participate
in the clinical and record-keeping audit annually.
KEY RELATED DOCUMENTS
Advanced musculoskeletal physiotherapy clinical governance guideline
Advanced musculoskeletal physiotherapy clinical education framework – work-based competency
standard and assessment
Allied health clinical governance guideline
107
Australian Physiotherapy Association documentation standards
http://www.physiotherapy.asn.au/DocumentsFolder/Advocacy_Position_Health_Records_2010.pdf
Key legislation, Acts and standards:
Charter of Human Rights and Responsibilities Act 2006 (Vic)2
RESOURCES
Guild Insurance Record-keeping self-test: retrieved 18 March 2013,
<http://www.riskequip.com.au/surveys/records-in-physiotherapy>.
Centre for Clinical Governance Research in Health, UNSW 2009, Clinical audit: a comprehensive
view of the literature; retrieved 18 March 2013, <http://clingov.med.unsw.edu.ai>.
Australian Medicare Locals Alliance (2013) Guidelines for conducting clinical audits, ATAPS clinical
governance implementation resource kit, retrieved 18 March 2013,
<http://www.amlalliance.com.au/medicare-local-support/primary-mental-health/ataps-clinicalgovernance-framework/ataps-clinical-governance-resource-kit>.
AUTHOR/CONTRIBUTORS
* denotes key contact
Name
Position
Service/program
* insert name
Grade 4 musculoskeletal
physiotherapist
Physiotherapy
Reminder: Charter of Human Rights and Responsibilities Act 2006 – All those involved in decisions based on this guideline
have an obligation to ensure all decisions and actions are compatible with relevant human rights.
2
108
TOOL 1: ADVANCED MUSCULOSKELETAL PHYSIOTHERAPY RECORD KEEPING AUDIT ASSESSMENT TOOL
Audit date:
Mark as appropriate below, each health record entry
against each criteria 1–40:  X N/A
Physiotherapist:
Health record entry number:
1
2
3
Assessor’s name (role) for each entry:
UR number:
General
Consent requirements met
Legible
Date of consult
Time of consult
Physiotherapy heading
Signature
Printed name
Page has UR sticker
Black or blue pen
All notations and abbreviations used are meaningful to those other than physiotherapists
Are personable comments excluded from all records
Single line through errors
Reason for alterations stated
Alterations initialled
109
Subjective assessment
Allergies noted
HOPC
Special questions – red flags, yellow flags, population-specific questions assessed
Past medical and surgical history
Current health status
Medications taken on the day and usual regimen
Social history
Smoker/alcohol/drugs
Objective assessment
Neurovascular status
Skin integrity
Other observations
Vital signs if indicated
Palpation findings
Functional status
Range of movement
Special tests / neuro
Investigations – referral information adequate, outcome documented
Reviewed by consultant?
Working diagnosis/impression
110
Management
Treatment
Warnings
Reassessment / action taken
Written information provided
Consultations
Name, position, outcome of consultation
Follow-up plan
Referrals
Discharge letter
Education and advice to patient
OVERALL RESULT: S = satisfactory; NS = not satisfactory
(80% correct of applicable criteria, required for satisfactory result)
S
NS
S
NS
S
NS
Signature of assessor:
111
Main areas identified for improvement (overall)
Action plan and timeframe
General
Subjective assessment
Objective assessment
Management/ consultations
112
Follow-up plan
Date:
Signature of the clinical lead/consultant:
Signature of the physiotherapist:
113
TOOL 2: ADVANCED MUSCULOSKELETAL PHYSIOTHERAPY CLINICAL AUDIT ASSESSMENT TOOL
Assessor (role):
UR number:
Physiotherapist:
Date:
Presenting condition:
Main areas identified for improvement
Evidence-based practice / best practice
Action plan (as agreed with physiotherapist)
Subjective assessment
Objective assessment
114
Diagnosis/impression (clinical reasoning)
Management/ consultations
Follow-up plan
Signature of assessor:
Signature of physiotherapist:
Date:
115
Advanced musculoskeletal physiotherapist – performance appraisal
Physiotherapist’s name:
Date:
Please
Circle:
Designs and performs an individualised, culturally appropriate and effective
patient interview.
Yes
No
6.1
Acts to ensure all ‘red flags’ and ‘yellow flags’ are identified in the assessment
process and takes appropriate action in a timely manner.
Yes
No
6.6
6.7
Performs complex modifications to routine musculoskeletal assessment in
recognition of factors that may impact on the process such as the patient
profile/needs.
Yes
No
6.3
Yes
No
6.4
Yes
No
6.2
Identifies when input is required from expert colleagues and acts to obtain their
involvement.
Yes
No
6.5
7.6
9.5
Uses concise, systematic communication at the appropriate level when
conversing with colleagues.
Yes
No
4.1
Presents all relevant information to expert colleagues when acting to obtain their
involvement.
Yes
No
4.2
8.4
Identifies when input to complement care is required from other health
professionals and acts to obtain their involvement.
Yes
No
11.5
Uses finite healthcare resources wisely to achieve best outcomes.
Yes
No
10.3
Provides appropriate education and advice to patients with common and/or
complex conditions.
Yes
No
11.6
Conducts a thorough handover to ensure patient care is maintained.
Yes
No
11.7
Works towards the full extent of their role.
Yes
No
1.2
Takes responsibility for own actions.
Yes
No
2.1
Designs and conducts an individualised, culturally appropriate and effective
clinical assessment that:
 is systems-based
 includes relevant clinical tests
 selects and measures relevant health indicators
 substantiates the provisional diagnosis.
Formulates a preliminary hypothesis and differential diagnoses for a patient with
common and/or complex conditions.
Comments:
Consultant’s name:
Consultant’s signature:
116
Oral appraisal (OA) assessment tool (screening clinic and ED soft tissue review clinic)
Candidate’s name:
Date:
Assessment linkage to competency standard: 1.1, 5.4, 9.3, 9.4, 13.4
Assessor’s name and designation:
Did the candidate satisfactorily answer the following questions?
Satisfactory = S
Not satisfactory = NS
Link to standard
competency
ELEMENTS AND PERFORMANCE CRITERIA
Performance
rating scale
S
Comments
NS
PROFESSIONAL BEHAVIOURS
1. Operate within scope of practice
Can you describe the scope of practice relevant for the role and provide
an example of what you might encounter that would be outside scope of
practice?
1.1
What is the definition of advanced scope of practice and how does it differ
from extended scope of practice?
PROVISION AND COORDINATION OF CARE
5. Evaluate referrals
Can you describe the patients who are appropriate for this advanced
musculoskeletal physiotherapy role in the context of the individual
physiotherapist?
5.4
117
Can you prioritise from attached list of referrals who should be seen in the
orthopaedic or neurosurgery clinics or the ED review clinic? (this will be
different for each advanced musculoskeletal physiotherapy service)
5.4
9. Apply the use of therapeutic medicines in advanced musculoskeletal physiotherapy
What legislation and registration requirements relating to medicines apply
to the physiotherapist working in advanced physiotherapy roles?
9.3,
9.4
What responsibilities apply to the physiotherapist in relation to the
recommending the use of medicines to patients?
13. Obtain patient consent
What is the process if a patient refuses to be seen by a physiotherapist
and requests to be seen by a doctor?
13.4
OVERALL COMPETENCE RESULT
Date:
Signature of assessor(s):
Satisfactory / unsatisfactory
Date:
Signature of candidate:
SPECIAL QUESTIONS / COMMENTS / FURTHER ACTION
ORGANISATIONAL RECORDING PROCESSES COMPLETED
 Yes
 No
Author:
Last review date:
Version:
Next review date:
118
Radiological interpretation of a plain-film case series: assessment tool (for the candidate)
Candidate’s name:
Date:
Assessment linkage to competency standard: 7.4
Area of advanced musculoskeletal physiotherapy: Orthopaedic and
neurosurgery screening clinics (ED review clinic to refer to the ED
radiological interpretation of a plain-film series)
Assessor’s name and designation:
ELEMENTS AND PERFORMANCE CRITERIA
Link to
competency
standard
Plain-film case series marking criteria instructions
PROVISION AND COORDINATION OF CARE
7. Apply the use of radiological investigations in advanced musculoskeletal physiotherapy
7.5 Interpret plain-film images accurately using a systematic
approach for patients with musculoskeletal conditions, as
relevant to the practice context
7.4






Score of plain-film case series
Candidate’s answers will be matched against the actual radiology report
Total marks available for each question will vary depending on whether
an abnormality is present or not and number of abnormalities
Candidate correctly identifies if image is normal or abnormal = 1 mark
If abnormal, candidate correctly identifies the anatomical site of
abnormality = ½ mark for each site and correctly describes each
abnormality to the satisfaction of the assessor = ½ mark
Candidate must indicate significance of injury, potential for associated
injuries, and indicate when referral onto medical team is warranted –
marks will be allocated accordingly
Score from each section should be total and added together for final
score
Satisfactory / not satisfactory
Comments / action plan
Signature of assessor:
Name of assessor:
Date:
119
Knee case
Normal/abnormal
X-ray – please describe and interpret findings
Marking
criteria
Please circle
1
Normal/abnormal
2
Normal/abnormal
3
Normal/abnormal
120
4
Normal/abnormal
5
Normal/abnormal
KNEE TOTAL
COMBINED TOTAL
Pelvis and hip
case
Normal/abnormal
X-ray – please describe and interpret findings
Marking
criteria
Please circle
1
Normal/abnormal
121
2
Normal/abnormal
3
Normal/abnormal
4
Normal/abnormal
5
Normal/abnormal
122
PELVIS AND HIP TOTAL
COMBINED TOTAL
Shoulder case
/
Normal/abnormal
X-ray – please describe and interpret findings
Marking
criteria
Please circle
1
Normal/abnormal
2
Normal/abnormal
3
Normal/abnormal
123
4
Normal/abnormal
5
Normal/abnormal
SHOULDER TOTAL
COMBINED TOTAL
Spinal case
Normal/abnormal
X-ray – please describe and interpret findings
Marking
criteria
Please circle
124
1
Normal/abnormal
2
Normal/abnormal
3
Normal/abnormal
4
Normal/abnormal
125
5
Normal/abnormal
SPINAL TOTAL
COMBINED TOTAL
/
126
PRE-ASSESSMENT CHECKLIST FOR WORKPLACE ASSESSORS: SELFASSESSMENT TOOL

Tacit knowledge of assessment area
Recent and broad experience in the area being assessed
Expertise in performance assessment processes
Working knowledge of the competency standard content
Working knowledge of the assessment plan and tool
Working knowledge of the responsibilities as an assessor including:
o
ensures assessment takes part in the practice setting
o
ensures the candidate has appropriate preparation for and information about the
assessment process
o
conducts assessments fairly
o
provides effective performance feedback
o
records results, maintaining confidentiality in accordance with organisational
requirements
Has relevant clinical competencies at least to the level being delivered or assessed by
virtue of a qualification, training or experience
127
CONDITIONS AND CONTEXT FOR ASSESSMENT: INSTRUCTIONS
Self-assessment using the Learning needs analysis tools is recommended for the candidate prior to
engaging in a work-based learning and assessment program. (Self-assessment will not be used as a
stand-alone method to make a decision of competence.)
Assessment tasks will be planned throughout the timeframe negotiated between the candidate and the
assessor. A combination of assessment occasions and methods will be used and are mapped on the
Learning and assessment plan. The Cumulative assessment tool collates all of the evidence gathered
through the assessment and, based on this evidence, the assessor makes and records an overall
assessment about the learner’s competence.
The assessment(s) will be conducted at a time that is mutually agreeable to both the assessor and the
candidate (making allowances for the impact access to appropriate patients may have on this).
When the assessment task requires direct workplace observation, this will be conducted in reality with
patient(s) appropriate for advanced musculoskeletal physiotherapy and within the practice context setting.
(The use of simulated contexts is discouraged and will only be implemented when there is no other
available, appropriate and timely method of assessment.)
Access to relevant guidelines, standards and procedures will be given during the assessment task.
To achieve competency, the candidate will provide sufficient evidence through planned assessment
activities, as determined by the assessor.
All competency elements and performance criteria must be satisfactorily met for the candidate to be
deemed competent.
The assessment must be conducted by a workplace assessor who meets the recommended minimum
criteria for assessors.
It is implicit that the candidate demonstrates appropriate knowledge during the whole assessment task.
If the candidate does not meet the expected standard of performance.
o
A plan will be made to address the performance gap. This may include opportunity for additional
teaching and supervised clinical practice. This will be made available prior to subsequent
assessments.
o
An additional assessment will be rescheduled at a time negotiated between the assessor and
candidate.
o
The candidate is permitted to engage another assessor if available/appropriate.
128
ASSESSMENT PREPARATION CHECKLIST:

Have you prepared all necessary equipment / assessment tools prior to the assessment?
Have you introduced yourself?
Have you verified the candidate is ready for assessment?
Have you informed the candidate about confidentiality issues regarding the assessment?
Have you provided an explanation of the parameters of the assessment (including the method
and context)?
Have you explained that in the event of unsafe practices the assessment will be terminated?
Have you invited the candidate to ask questions before the assessment begins?
Have you described the assessment scenario in a clear and non-ambiguous manner?
129
GUIDELINES FOR ASSESSORS DURING A DIRECT WORKPLACE OBSERVATION ASSESSMENT
Use ‘non-prompting’ and ‘non-involvement’ behaviour.
Provide succinct clarification on request, without suggestive prompting.
Use follow-up questioning at the conclusion of the direct observation to clarify or address outstanding
performance criteria (a list of potential clarifying questions has been included with the direct work
observation tool).
Inform the candidate of the outcome of the assessment in a timely manner.
Provide effective feedback at the completion of the assessment.
o
Be concise. Focus on behaviour (not personality) and engage the candidate in a discussion of
performance.
o
Discuss areas performed well.
o
Discuss areas requiring improvement.
o
Document the outcome of the assessment on the tool.
Communicate effectively with a candidate who is ‘not yet competent’ about the performance rating
given.
o
Communicate objective reasons for non-competence / the rating.
o
Negotiate an action plan with the candidate to develop skills for successful completion /
performance improvement.
o
Agree on a timeframe for an ongoing Learning and assessment plan.
o
If applicable/available, offer an alternate assessor.
130
Curriculum overview
Orientation program
One of the requirements in the Learning and assessment plan is to complete an orientation program
for the role. All new staff to the organisation should undergo the routine staff orientation process in
addition to the specific orientation program developed for the role of advanced musculoskeletal
physiotherapist (refer to orientation manual developed at local site and included in the operational
guidelines). An orientation program will be specific to the advanced musculoskeletal physiotherapy
service. For example, a minimum of one session of observing/shadowing with either an experienced
physiotherapist already working in the role prior to seeing patients in the screening clinics is
recommended. For a physiotherapist new to the advanced practice role a reduced clinical load with
direct access to the clinical lead physiotherapist during the clinic may be recommended for the first
two clinical sessions. Prior to observing a session, the physiotherapist should achieve the following
objectives:









Complete the organisation’s staff orientation process.
Complete an orientation specific to the screening clinic / ED soft tissue review clinic and
advanced practice role.
Complete an orientation to the physiotherapy department.
Complete an orientation and introduction to the orthopaedic or neurosurgical team as
appropriate including consultants and registrars where practicable.
Completed the workplace observation (skills checklist) with relevant personnel.
Get familiar with the hospital and clinic IT system(s) and acquire the necessary IT access.
Complete the online radiation safety module:
http://www.imagingpathways.health.wa.gov.au/index.php/radiation-training-module.
Complete Learning needs analysis Part A and B and meet with a mentor to discuss Learning
and assessment plan.
Complete module 10 on communication (ISBAR).
Curriculum development
An example of how the curriculum might look is provided below. Not all the self-directed learning
modules may be applicable depending on the model of care being implemented; for example, wounds
may not be required, and some self-directed learning modules may be considered for more advanced
learning and experience, and therefore used at a later stage such as differential diagnosis,
pharmacology and diabetes. The focus of the learning program should be directed at assisting the
physiotherapist to acquire the necessary underpinning skills and knowledge to perform as per the
performance criteria described in the competency standard.
131
Example of a curriculum timeline (full time physiotherapist who has met the selection criteria working as an advanced
musculoskeletal physiotherapist in the orthopaedic or neurosurgery screening clinics)
ORIENTATION
Block 1
Block 2
Block 3
Block 4
Orientation program
SELF-DIRECTED
LEARNING MODULES
SELF-DIRECTED
LEARNING MODULES
SELF-DIRECTED
LEARNING MODULES
SELF-DIRECTED
LEARNING MODULES
Musculoskeletal conditions
 Cervical spine
 Lumbar spine
Musculoskeletal conditions
 Shoulder
 Knee
Musculoskeletal conditions
 Hip
 Ankle
 Foot
Radiology
 Indications for
imaging
 Requesting imaging
Radiology
 Interpreting plainfilm imaging
Musculoskeletal
 Elbow
 Wrist
 Hand
 Thoracic spine
Pharmacology
In-service: Radiology
Interpreting plain film?
In-service: Pharmacy or
anaesthetics – analgesia
In-service: Neurosurgery
Spinal surgery
REDUCED CLINICAL LOAD
WITH ACCESS TO
CLINICAL LEAD TWO (2)
CLINICS
MEET WITH MENTOR
Formative assessment
CASE-BASED
PRESENTATION 1
Workplace observation (skills
checklist) with consultant
SELF-DIRECTED
LEARNING MODULES
(not all modules may be
required**)
Radiology
 Radiation safety
 Complete quiz (80%
pass rate)
Communication
Complete Learning needs
analysis Part A and B and
discuss in collaboration with
clinical lead to develop
individualised Learning and
assessment plan
MEET WITH MENTOR
Discuss Learning needs
analysis Part A and B
In-service: Orthopaedic
surgeon
What makes a good surgical
candidate?
OBSERVE/SHADOW
CLINIC ONE (1) CLINIC
Differential diagnosis of nonmusculoskeletal conditions
132
Block 5
Block 6
Block 7
Block 8
Block 9
WORKPLACE
COMPETENCY
ASSESSMENT
SELF-DIRECTED
LEARNING MODULES
SELF-DIRECTED
LEARNING MODULES
Diabetes APA modules
1, 2 or in-house
equivalent
SELF-DIRECTED
LEARNING MODULES
Diabetes APA modules
3, 4 or in-house
equivalent
SELF-DIRECTED
LEARNING MODULES
REVISION

Present clinical log
and professional
practice portfolio

Oral appraisal

Direct workplace
observation x 1–2

Written test/quiz

Performance
appraisal

Further case-based
presentations as
required

Skills assessment
(consultant)

Record-keeping
audit
Pathology
In-service: Pathology
Routine bloods
MEET WITH MENTOR
Formative assessment
In-service: Diabetes
educator
CASE-BASED
PRESENTATION 2
MEET WITH MENTOR
Formative assessment
CASE-BASED
PRESENTATION 3
MEET WITH MENTOR
Prepare for work-based
competency
assessment
Repeat Competency
standard selfassessment tool
133
Glossary
Refer to the manual of the Advanced musculoskeletal physiotherapy clinical education framework.
References
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df>
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physiotherapists with an extended scope of practice, Scotland, UK
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134
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136
Appendix
Learning and assessment plan template
TITLE OF COMPETENCY
STANDARD(S) TO BE
ACHIEVED
ASSESSMENT TIMEFRAME
WORKPLACE LEARNING
DELIVERY OVERVIEW
Deliver Advanced Musculoskeletal Physiotherapy in the insert area of practice
To be negotiated with clinical lead physiotherapist, assessor &/or line manager
A combination of the following will be implemented
 Self-directed learning
 In-house in-services
 Coaching or Mentoring
 Workplace application
 Formal external learning
1. LEARNING ACTIVITIES / RESOURCES
TASK DESCRIPTION
1. Complete Learning Needs
Analysis for the work role
2. Complete site specific
orientation to ED
3. Complete self-directed
learning modules as required
from the Learning Needs
Analysis.
Completed
 X
Complete Learning Needs Analysis Part A and B, and discuss learning needs, evidence of
prior learning, and assessment/ verification processes with clinical lead
physiotherapist/supervisor/ mentor
Complete orientation covering all details outlined in the site specific orientation guideline
Select self-directed learning modules to complete (delete or add additional learning
modules relevant to area of practice):
1. Musculoskeletal conditions/presentations
2. Radiology
3. Modules specific to area of practice
4. Wounds
5. Pharmacology
6. Pathology
7. Differential Diagnosis
8. Paediatrics
137
4. Complete formal training e.g.
Radiology, Pharmacology and
Diabetes
5. Complete further individual
learning as required from the
Learning Needs Analysis
6. Undertake supervised clinical
practice & feedback sessions
9. Diabetes (APA diabetes e module)
10. Communication(ISBAR)/Consent/Documentation
(add or delete)
 University of Melbourne Radiology single subject
Subject Code: RADI90001 Radiology for Physiotherapists
 University of Melbourne Pharmacology single subject (TBC)
 APA e modules Diabetes for Physiotherapists
http://www.learningseat.com/servlet/ShopLearning?categoryName=Browse+%BB+Phys
iotherapy/Clinical+Content+%BB+Diabetes+For+Physiotherapists++8+CPD+Hours&learningId=38954
 Other
Complete further individualised learning as discussed with and directed by clinical
supervisor/ line manager. This may include material beyond what is covered in the learning
modules above.
List below:





Physiotherapists new to the work role who are undertaking the full learning &
assessment pathway our encouraged to engage in a structured/timetabled work
program as advised and negotiated with their clinical supervisor/assessor.
Physiotherapists new to the role should complete an orientation program which
includes shadowing and observation
Until an individual is deemed competent to practice independently within the setting
it is recommended they have access to senior medical /physiotherapy staff for
clinical supervision.
A graduated process from direct to indirect clinical supervision should be
maintained during this period until performance is at an independent standard and
physiotherapists will be supported by specific targeted feedback during this time, to
address learning needs
A formative assessment should be conducted early into commencing the role and
throughout the supervision period to help the physiotherapist prepare for work place
138
observation assessment(s) and oral appraisal. The formative assessment may be
conducted by the clinical lead physiotherapist however the work place observation
could be conducted by an ED consultant familiar with the Competency Standard.
7. Review the following
documents and become familiar
with the content in relation to
advanced musculoskeletal
physiotherapy

•
•
•
•


•
8. Other activities to be advised
Australian Physiotherapy Standards
http://www.physiocouncil.com.au/files/the-australian-standards-for-physiotherapy
APA scope of practice
http://www.physiotherapy.asn.au/DocumentsFolder/Advocacy_Position_Scope_of_
Practice_2009.pdf
AHPRA Code of conduct/registration requirements
http://www.physiotherapyboard.gov.au/Codes-Guidelines.aspx
Processes for issuing of sick leave certificates/WC
Local organisational guidelines /clinical governance structure
State Drugs and Poisons act : http://www.health.vic.gov.au/dpcs/reqhealth.htm
Poisons Standard 2010: http://www.comlaw.gov.au/Details/F2010L02386
Paediatric legislation/standards
1. It is recommended the trainee conduct a self-assessment of their clinical recordkeeping at intervals during the training program, in preparation for the record
keeping audit and using the record-keeping audit assessment tool.
Insert other learning activities.
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2. ASSESSMENT DETAILS & LINKAGE
ASSESSMENT TASK
1. Complete written responses (WR)
Due date
Performance
Criteria
**Add Performance
Criteria from
Competency
Standard to
assessment task
7.1, 7.5
Provide details of assessment task
2. Participate in direct workplace observation (WO)
For an agreed period of time the physiotherapist will work under supervision, and the physiotherapist when
deemed ready by self and supervisor, will undergo formal observation in the workplace.
 The physiotherapist’s level of performance will be rated against the standard by the designated
assessor, using assessment tool(s) during a formal assessment process.
 Occasions of direct workplace observation will be negotiated by the assessor with the
physiotherapist.
 It is recommended that these observations of clinical practice are to include patient presentations
with signs and symptoms most common in presentation to area of practice
 Who the assessor is will vary depending upon the local organisation’s requirements. The assessor
could be a consultant or an experience physiotherapists who is familiar with the assessment process
and competency standard requirements.
Provide details of assessment task
3. Maintain a professional practice portfolio (PF)
6.1-6.7, 7.1-2, 7.5,
9.1, 10.1-2, 11.1-4,
13.1-3,
17.1-6, 17.9-10
Add performance
criteria where
required
3.3
The professional practice portfolio required is consistent with the requirements of the APA’s requirements
and should include relevant information regarding attendance and participation in formal and informal
education and learning opportunities specific to advanced musculoskeletal physiotherapy area of practice.
This may include:
 self-reflective journal/diaries
 in-services, lectures, journal clubs, continuing education programs attended or given
 quality projects
 research activities and publications
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 conference attendance
 mentoring/supervision sessions
 an electronic clinical log of types of conditions seen
Please refer to:
 APA continuing development guidelines
www.physiotherapy.asn.au/APAWCM/Learning_and_Development/CPD_Overview/APAWCM/Learn
ingDevelopment/CPD_Overview.aspx
 APHRA guidelines for continuing education
www.physiotherapyboard.gov.au/documents/default.aspx
4. Provide documentary evidence (DE)
For Example:
Participation in a record keeping audit – It is recommended that physiotherapists are required to provide
documentary evidence of pre-determined number of health record entries, which will be audited using an
audit assessment tool, by an assessor such as the clinical lead Physiotherapist or a peer. Performance will
be rated as satisfactory if at least 80% of the applicable criteria are included in the samples. Feedback will
be provided to the physiotherapist and recommendations for improvement documented with a plan to ensure
recommendations are implemented. Record keeping practice should be in line with the local organisation’s
policies and the APA Position Statement on health records.
5. Give case based presentations (CBP)
It is recommended that physiotherapists present a predetermined number of cases (insert number) to
colleagues at a frequency designated by the assessor/clinical lead/supervisor
 It will be supported by verbal questioning by the assessor, centring on advanced clinical decision
making.
 The level of performance will be rated against the standard by the designated assessor, using the
appropriate case based presentation assessment tool(s).
The presentations should address the required performance criteria as identified in this learning and
assessment plan. Additional performance criteria may be added and addressed in case based
presentations.
6. Participate in performance appraisal (PA)
It is recommended that a performance appraisal should be conducted at the completion of an agreed
timeframe by an allocated consultant or experienced physiotherapist who has worked regularly with the
physiotherapists being assessed. This appraisal is based on an informal observation of clinical practice over
a period of time.
7.4, 9.8, 14.1
6.1-7, 8.1, 8.5, 9.1,
10.1-2, 11.1-4,
16.1-5, 17.1-3,
17.5-6
Add performance
criteria where
required
Insert performance
criteria
141
7. Undertake external qualification/training (Q/T)
It is recommended the physiotherapist undertakes further external training. Examples of this may include:
 University of Melbourne single subject in Radiology
 APA Diabetes learning modules 1-4
To be guided by local organisation policies and guidelines.
8. Participate in oral appraisal (OA)
An oral appraisal can be conducted to assess aspects of workplace performance, as required and at the
discretion of the assessor (Consultant or Clinical Lead physiotherapist) in relation to the relevant
performance criteria. Refer to the OA assessment tool.
Insert performance
criteria
Insert performance
criteria
It is recommended that this oral appraisal is conducted when the physiotherapist is ready to submit all forms
of evidence for a final assessment of competency to the designated assessor who maybe the Clinical Lead
physiotherapist or nominated Consultant.
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